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

Arvind Vatkar, Sachin Kale, Rohan Jayaram, Ashmit Verma, Saurabh Pandey, Sachiti Kale
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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.

三级卫生保健中心创伤患者早期明确治疗的1年随访结果
导言:道路交通事故(RTA)在全球发病率和死亡率中占相当大的一部分,在年轻和活跃的个人中发病率特别高。呈现多发创伤的患者需要多学科方法指导下的协议晚期创伤生命支持。病例报告:我们报告一名31岁女性病例,于2023年6月17日在RTA术后接受初级护理后转至我们中心。在另一家医院的初步评估发现,她的内伤伴有多处骨折——右侧胸血和肺挫伤,肝脏、脾脏和肾脏有3级损伤。患者,谁也被发现是怀孕,提出了我们的设施低血压和呼吸困难。稳定工作包括在重症监护室复苏后的呼吸支持。在实现血流动力学稳定后,我们精心规划并实施了早期的最终固定,并在股骨髓内钉、左腕切开复位内固定和右髋臼经皮固定。尽管术后出现胸腔积液、皮下肺气肿等并发症,但患者恢复明显,并于2023年6月27日成功拔管。她出院时生命稳定,并在她的住所继续康复。在术后1年随访期结束时,患者成功恢复了所有关节的活动范围,骨折愈合良好。结论:本病例强调了针对多发伤的独特入路的重要性。虽然损伤控制矫形术通常被推荐用于不稳定的患者,但在患者成功复苏和稳定的情况下,必须考虑早期明确的矫形护理,这总是能改善创伤结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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