Abstract text (incl. references and figure legends)
Case history
A 61-year-old man fell on both legs from a 10-meter-high tree.
Clinical findings
On arrival, he was notable for having a clear airway, a respiratory rate of
24 breaths per minute, and a SpO2 of 93% without additional oxygen. The pulse rate was
100 beats per minute, and the blood pressure was 100/70 mmHg. No signs of paralysis or
open wounds on the limbs were observed. The left hemithorax, lumbar, and suprapubic
regions were painful. The left knee was swollen. The right leg was shortened and externally
rotated, with a painful calcaneus.
Investigations and results
The patient was in class II hemorrhagic shock. FAST showed
retroperitoneal hemathoma. A WBCT with contrast was performed and showed bilateral
sacral and right pubic rami fractures with active extravasation of contrast at fracture sites
and from the sacral venous plexus. No active arterial extravasation was detected. A left
pulmonary contusion, fractures of the proximal tibia, fibula, calcaneus, and both L5
processes transversus were seen.
Diagnosis
Vertically unstable pelvic fracture with retroperitoneal hemorrhage; contusion of
the lower left pulmonary lobe; fracture of the left tibial plateau and proximal fibula;
multifragmentary fracture of the right calcaneus; bilateral fracture of the transversus process
of the 5th lumbar vertebra.
Therapy and progressions
He received 3 units of RBC. We performed DCS with the
application of a pelvic external fixator. On day five, we performed definitive pelvic
stabilization. Two weeks after the injury, osteosynthesis of the proximal tibia with an
angulary stable plate was performed. We treated the calcaneal fracture conservatively.
Comments
A multidisciplinary approach with defined diagnostic and treatment modalities
and appropriate timing saves a patient with multiple injuries.
References
1. Coccolini et al. World Journal of Emergency Surgery (2017) 12:5.
2. Prat-Fabregat S, Camacho-Carrasco P. Treatment strategy for tibial plateau fractures: an
update. EFORT Open Rev (2016) ;1:225-232.
3. Frassini et al. Emergency Management of Pelvic Bleeding. J. Clin. Med. (2021); 10, 129.
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