open access

Vol 68, No 3 (2017)
MARITIME MEDICINE Case report
Published online: 2017-09-27
Submitted: 2017-08-17
Accepted: 2017-08-29
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Non-operative management of a patella fracture: environmental considerations in the Subantarctic

Fraser John Gould
DOI: 10.5603/IMH.2017.0028
·
Pubmed: 28952661
·
International Maritime Health 2017;68(3):159-162.

open access

Vol 68, No 3 (2017)
MARITIME MEDICINE Case report
Published online: 2017-09-27
Submitted: 2017-08-17
Accepted: 2017-08-29

Abstract

Injuries occurring in the remote environment present particular challenges to healthcare professionals, and decisions need to be carefully made on an individual basis. This report describes the successful management of a patella fracture sustained on the Subantarctic island of South Georgia. A 36-year-old boating officer presented to the island surgery after sustaining an isolated closed injury to his left knee. On physical examination there was a large effusion palpable within the joint, and on subsequent radiography an undisplaced transverse fracture of the patella was apparent. The patient had an intact and competent extensor mechanism, and fulfilled indications for non-operative management. His clinical case was discussed with supervising consultants at the British Antarctic Survey Medical Unit in the United Kingdom, and radiographs forwarded electronically for an orthopaedic review. The decision was made to undertake medical evacuation of the patient. There were additional environmental factors to be considered in this situation. The terrain on South Georgia is rugged and unforgiving, there is a risk of injury posed by the local fauna (Arctocephalus gazella) during summer months, and emergency evacuation from the base would be difficult for any person with restricted mobility. A planned retrieval enabled our patient to continue rehabilitation and physiotherapy in the preferrential setting of his home country, without causing undue delay in time taken returning to work in this remote location.  

Abstract

Injuries occurring in the remote environment present particular challenges to healthcare professionals, and decisions need to be carefully made on an individual basis. This report describes the successful management of a patella fracture sustained on the Subantarctic island of South Georgia. A 36-year-old boating officer presented to the island surgery after sustaining an isolated closed injury to his left knee. On physical examination there was a large effusion palpable within the joint, and on subsequent radiography an undisplaced transverse fracture of the patella was apparent. The patient had an intact and competent extensor mechanism, and fulfilled indications for non-operative management. His clinical case was discussed with supervising consultants at the British Antarctic Survey Medical Unit in the United Kingdom, and radiographs forwarded electronically for an orthopaedic review. The decision was made to undertake medical evacuation of the patient. There were additional environmental factors to be considered in this situation. The terrain on South Georgia is rugged and unforgiving, there is a risk of injury posed by the local fauna (Arctocephalus gazella) during summer months, and emergency evacuation from the base would be difficult for any person with restricted mobility. A planned retrieval enabled our patient to continue rehabilitation and physiotherapy in the preferrential setting of his home country, without causing undue delay in time taken returning to work in this remote location.  

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Keywords

knee, South Georgia, remote, evacuation

About this article
Title

Non-operative management of a patella fracture: environmental considerations in the Subantarctic

Journal

International Maritime Health

Issue

Vol 68, No 3 (2017)

Pages

159-162

Published online

2017-09-27

DOI

10.5603/IMH.2017.0028

Pubmed

28952661

Bibliographic record

International Maritime Health 2017;68(3):159-162.

Keywords

knee
South Georgia
remote
evacuation

Authors

Fraser John Gould

References (8)
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  7. Government of South Georgia & the South Sandwich Islands. Annual Tourism and Visitor Report 2015–16. http://www.gov.gs/docsarchive (2015).
  8. Council of Managers of National Antarctic Programmes (COMNAP). Understanding Risk to National Antarctic Program Operations and Personnel in Coastal Antarctica from Tsunami Events. http://www.ats.aq/index_e.htm (2011).

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