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Non-operative management of a patella fracture: environmental considerations in the Subantarctic
Affiliations- Medical Officer, British Antarctic Survey Medical Unit, United Kingdom
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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.
Keywords
knee, South Georgia, remote, evacuation
About this articleTitle
Non-operative management of a patella fracture: environmental considerations in the Subantarctic
Journal
Issue
Article type
Case report
Pages
159-162
Published online
2017-09-27
Page views
2491
Article views/downloads
4019
DOI
Pubmed
Bibliographic record
IMH 2017;68(3):159-162.
Keywords
knee
South Georgia
remote
evacuation
Authors
Fraser John Gould
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