[Intramedullary stabilization of bilateral femur fractures with pulmonary artery embolism].

This is a case report of a 31-year-old motorcyclist who was admitted to our emergency department with severe multiple injuries and an ISS score of 38 points.There were bone injuries on all 4 extremities, fractures of both proximal femurs, both radii, a great soft tissue injury of the lower limb, stable fractures of the spine and a blunt thoracic injury. A bone fragment compressed femoral vein and artery on the right side with consecutive thrombus in the inferior caval vein and thrombembolism of the central lung artery. The proximal femur fractures were treated initialy with gamma-nails after implanting a cava-filter because of the high-risk constellation for further thrombembolism. Operation was monitored with transesophageal echocardiography.The cava filter could be delivered on 2nd postoperative day without complication. The patient was ventilated for 1 day, stayed on ICU for 9 days and left hospital in a good condition after 28 days. It was the strategic and logistic great achievement of an interdisciplinary trauma center to implant cava filter and decide for intramedullar osteosythesis without delay.