1-Year Follow-Up Result of Early Definitive Management of the Trauma Patient in a Tertiary Health Care Centre.

Abstract

Introduction: Road traffic accidents (RTA) account for a sizable portion of morbidity and mortality globally, with a particularly high incidence among young and active individuals. Patients presenting with polytrauma require a multidisciplinary approach guided by protocols for advanced trauma life support.

Case report: We report the case of a 31-year-old female, transferred-in to our center following primary care after an RTA on June 17th, 2023. Initial assessment at the other hospital found multiple fractures accompanying her internal injuries - a right haemothorax and pulmonary contusion, with Grade 3 injuries to the liver, spleen, and kidneys. The patient, who was also found to be pregnant, presented to our facility with hypotension and breathlessness. Stabilization efforts spanned to include ventilatory support following resuscitation in the intensive care unit. Upon achieving hemodynamic stabilization, early definitive fixation was meticulously planned and implemented, leading to intramedullary nailing of the femur, open reduction and internal fixation in the left wrist, and percutaneous fixation of the right acetabulum. Despite landing in post-operative complications such as pleural effusion and subcutaneous emphysema, the patient showed remarkable recovery and was successfully extubated on June 27th, 2023. She was discharged vitally stable, and continued recovery at her residence. The patient managed to regain full range of motion in all joints, with good union of fractures at the end of her 1-year post-operative follow-up period.

Conclusion: This case highlights the importance of tailoring an approach which was unique to the polytrauma presentation. While damage control orthopaedics is often recommended in unstable patients, early definitive orthopedic care must be considered where patients are successfully resuscitated and stabilized, invariably improving trauma outcomes.