Cervical bleeding injury after motorcycle road accident management in polytrauma patient

Abstract text (incl. references and figure legends)

Case history: A 49-year-old male victim of a motorcycle crash into another vehicle, brought by pre-hospital emergency to our hospital with a cervical wound and laceration of the left external jugular vein (LEJV).

Clinical findings: He presented hemodynamically stable, with cervical bleeding controlled by external compression and cervical immobilization. Airway was apparently not compromised and orotracheal intubation was performed maintaining manual cervical traction after removing cervical collar and excluding tracheal injury and other cervical injuries. He also had pubic region swelling and was stabilized with a pelvic binder.

Results: CT scan showed preservation of the carotid vascular axis, fractures of the spinous process of C6 and transverse processes of C6-T1, left clavicle, virtually all left ribs and diastasis of the pubic symphysis and right sacroiliac joint.

Diagnosis: Polytrauma with cervical, clavicular and rib fractures, pelvic APC III fracture and cervical injury with laceration of LEJV.

Therapy and progressions: Surgical exploration of the cervical wound was performed, with ligation of the LEJV extremities. The patient was admitted to the intensive care unit. Pelvic ring fracture was initially managed by osteotaxis with external fixator to the iliac crests and deferred definite treatment with osteosynthesis of sacroiliac fracture was performed at day 5 and pubic symphysis with plate and screws at day 15. Cervical immobilization was maintained until surgical arthrodesis at day 19. The other fractures were managed with a conservative approach and a left erector spinae plane block catheter was placed for better pain control. The patient was discharged from ICU on day 25, fully awake and conscious, breathing on room air, with a sensory-motor deficit on the left arm due to left brachial plexus injury and no other neurological deficits.

Comments: This case highlights the importance of damage control, prioritizing the approach of different injuries in polytrauma patients, with deferred definitive treatment after stabilization. Airway protection is also important and special care should be taken in its management, given the cervical trauma.

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