Bone missile injury with an intact host femur after high energy road traffic trauma: a case report.

Abstract

A 28 year old woman presented with local wound infection two weeks after sustaining an anterior thigh laceration in a high energy motorbike crash that killed the co-riding motorcyclist. X-ray revealed a non-identifiable radio-opaque fragment and computed tomography identified a bony foreign body deep in the thigh adjacent to the femoral vessels, with the host femur intact. A 6 x 3 cm fragment of cortical bone was removed at surgery. Histopathology and genetic studies to confirm its origin were not feasible in this resource-limited setting, but an intact host femur suggested it originated from the deceased rider. The wound healed by secondary intention, HIV and hepatitis serology were negative at 6 weeks. This case highlights the unusual occurrence of a bone missile and the importance of early advanced imaging and prompt post-exposure prophylaxis following high-energy, multi-victim trauma.