[ARDS after unreamed femoral nailing]

An 18-year-old male patient sustained right-sided femoral and 2nd degree open tibial shaft fractures following a motorcycle accident. Further injuries, and thoracic injury in particular, were excluded clinically and radiologically. Early stabilization of the fractures was achieved by external fixation of the tibia followed by unreamed femoral nailing.Postoperatively, severe deterioration of pulmonary function led to the progressive development of an adult respiratory distress syndrome (ARDS) and necessitated extracorporal membrane oxygenation (ECMO) of the ventilated patient for 89 h. Subsequently, the patient's gas exchange parameters improved allowing extubation 1 week after the accident. Secondary tibia nailing and further recovery of the patient were uneventful.