A gentlemen came to our trauma centre with history, the bus ran over the motorcyclist (helmeted) primary survey done according to American College of Surgeons ATLS protocol.
Airway clear and cervical spine protected
Breathing Right pneumothorax – icd placed
Circulation – patient was in tachycardia and hypotensive . pelvic fracture so Pelvic Circumferential Compression Device applied .
After 1L RL patient respond. On stable vitals patient shift to radiology department for whole body scan.
Cect abdomen shows –
- perforation in anterior wall of anorectal canal with extra peritoneal extension of rectal contrast
- Pubic diastasis and sacral fractures
CT ANGIO – Displaced fracture is seen in mid shaft of left femur. Fracture of medial femoral condyle is also seen. There is also segmental fracture of mid shaft of left tibia. Fracture of head of left fibula and proximal shaft of fibula is also seen.
Complete block is seen in distal superficial femoral, popliteal and proximal leg arteries on left side. Flow is absent in distal leg and foot region on left side. Left leg blacking started .
Plan –
- Trephine stoma for rectal injury
- External fixators for pelvic
- Above knee amputation for left leg crush injury ( LIFE OVER LIMB)
- Cystoscopy during surgery for blood in urine and DJ stent placed
Continuous monitoring and daily dressing Some other surgeries also performed like stoma closure , plating and DJ stent removal done
For rehabilitation of patient Jaipurfoot – BMVSS given to patient .