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Case Reports
. 2024 May 17:52:101037.
doi: 10.1016/j.tcr.2024.101037. eCollection 2024 Aug.

A case of damage control after polytrauma and bilateral femur fracture

Dana Avraham  1 , Amir Herman  1 , Maria Oulianski  1
Affiliations
Case Reports

A case of damage control after polytrauma and bilateral femur fracture

Dana Avraham et al. Trauma Case Rep. .

Abstract

Introduction: Multi-trauma patients require a multidisciplinary team, especially in the presence of various body systems injuries. The evaluation focuses on the decision regarding the DCO and ETC approaches.

Case presentation: A 24-year-old male patient with Glasgow Coma Score 8, arrived at the emergency room, followed by ATLS protocol. Orthopedic trauma included D8 vertebra unstable burst fracture, right open femur shaft fracture, left closed midshaft femur fracture, and right tibial plateau fracture of the knee.

Case summary: A hemodynamically stable patient with bilateral femur fractures is directed toward the DCO approach.

Discussion: An initial treatment for an external fixator across the knee on the right leg and a spine fusion and decompression of D5-10 surgery was made on the day of admission. Definitive fixation and conversion to internal fixators were done on day 9 after the accident. Postoperative drop-foot injury was seen in the right leg. A Masquelet technique was applied for the right femur segmental fracture due to gaps.

Conclusion: DCO may be employed to temporarily stabilize fractures, allowing the patient to recover from other life-threatening injuries before definitive fixation. Further secondary procedures, such as the Masquelet technique, should be considered to optimize the results. Long-term follow-up and rehabilitation are part of recovery, aiming to optimize functional recovery and improve the patient's quality of life.

Keywords: Damage control; Early total care; Femur shaft fracture; Masquelet; Multi trauma.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
A case of damage control after polytrauma and bilateral femur fracture.
Fig. 2
Fig. 2
Sagittal plane CT scan of the patient's thoracic spine showing 3-column fracture of D8 vertebra.
Fig. 3
Fig. 3
3D CT scan of the patient's lower limbs.
Fig. 4
Fig. 4
Tibial plateau X-ray taken during the cross-knee Ex-Fix application.
Fig. 5
Fig. 5
Intraoperative imaging of the right femur after cross-knee Ex-Fix application demonstrating the gap defect in the right femur.
Fig. 6
Fig. 6
Intraoperative imaging of the left femur after Ex-Fix application.
Fig. 7
Fig. 7
intraoperative imaging of the spinal posterior fixation D5-D10 (A-AP; B-lateral views).
Fig. 8
Fig. 8
Postoperative image of the right femur 1 month after masquelet procedure stage 1 (A-both legs images; B-zoom in of the right femur).
Fig. 9
Fig. 9
Routine follow-up 6 months after the accident.
See this image and copyright information in PMC

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