Vatkar Arvind, Kale Sachin, Jayaram Rohan, Verma Ashmit, Pandey Saurabh, Kale Sachiti
Consultant Orthopaedic spine surgeon, Apollo Hospital, Belapur, Navi Mumbai, India.
Department of Orthopaedics, MGM Medical College, Nerul, Navi Mumbai.
J Orthop Case Rep. 2025 Jan;15(1):183-188. doi: 10.13107/jocr.2025.v15.i01.5170.
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.
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.
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.
道路交通事故（RTA）在全球 morbidity 和 mortality 中占相当大的比例，在年轻活跃人群中发病率尤其高。多发伤患者需要以高级创伤生命支持方案为指导的多学科方法。
我们报告一例 31 岁女性病例，她于 2023 年 6 月 17 日发生道路交通事故后在接受初级护理后转至我院。另一家医院的初始评估发现她有多处骨折并伴有内伤——右侧血胸和肺挫伤，肝脏、脾脏和肾脏为 3 级损伤。该患者还被发现怀孕，因低血压和呼吸急促前来我院。稳定病情的努力包括在重症监护病房复苏后进行通气支持。在实现血流动力学稳定后，精心规划并实施了早期确定性固定，包括股骨髓内钉固定、左手腕切开复位内固定以及右髋臼经皮固定。尽管术后出现了胸腔积液和皮下气肿等并发症，但患者恢复显著，于 2023 年 6 月 27 日成功拔管。她出院时生命体征稳定，在家中继续康复。患者术后 1 年随访结束时所有关节均恢复了全范围活动，骨折愈合良好。
本病例突出了针对多发伤表现制定独特治疗方法的重要性。虽然对于不稳定患者通常推荐损伤控制骨科，但对于成功复苏并稳定的患者，必须考虑早期确定性骨科治疗，这必然会改善创伤治疗效果。
