# “Terrible Triad” Injury in an Adolescent Patient With a High-Energy Femoral Shaft Fracture: A Case Report

## TL;DR

A young patient with a femur fracture and multiple complications is described, highlighting a rare sequence of injuries and surgical challenges.

## Contribution

The paper introduces the concept of a 'terrible triad injury' in femoral shaft fractures involving implant failure and patellar tendon rupture.

## Key findings

- The patient required multiple surgeries due to implant failure and complications.
- A 'terrible triad injury' sequence was identified involving femoral fracture fixation, revision, and patellar tendon rupture.
- Current guidelines for surgical fixation in polytrauma patients with respiratory dysfunction are lacking.

## Abstract

Although femoral shaft fractures are typically treated with intramedullary nailing, alternative fixation methods like plating are required in select cases, particularly when nailing may be contraindicated due to respiratory complications or other patient-specific factors. Currently, there are no established guidelines for the optimal surgical fixation method of femoral shaft fractures in polytrauma patients with respiratory dysfunction. We present the case of a young patient with a diaphyseal femur fracture who underwent multiple surgical interventions within three months due to recurrent injuries and complications, primarily resulting from non-adherence to postoperative guidelines. We describe this sequence as a "terrible triad injury", consisting of primary fixation of the femoral fracture, revision of the first osteosynthesis due to recurrent trauma and implant failure, and a subsequent patellar tendon rupture.