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e-CASES: Occipital Condyle Fracture, Thoracic injuries, Hepatic trauma, Adrenal hemorrhage

History

High-speed road accident of single light vehicle against plane tree, not wearing seatbelt.

 

Initial treatment by Fire Department, Glasgow = 10, obnubilation, both pupils non-reactive, unstable hemodynamics with blood pressure: 75/40,pulse: 110, responding to IV fluid therapy, no respiratory distress, and incarceration of both inferior extremities with open fracture of the right ankle requiring 45 min to be released.

1.5 liters IV fluids, intubation after rapid induction sequence, mechanical ventilation, sedation, reduction of fracture of right inferior extremity. Prophylactic antibiotics.Medical transport to university hospital.

 

The body scan is provided.

Findings

My report:

 

Cranioencephalic space: No traumatic lesions.

 

Spinal space:

Stable, unilateral, non-displaced, large-fragment articular fracture of the left occipital condyle (Anderson type II):No other posttraumatic lesion of the cervico-thoraco-abdomino-pelvic spine.No posttraumatic lesions of the neck vessels (note that the right vertebral terminates in the posteroinferior cerebellar artery).

 

Thoracic space:

Sparse ground-glass pulmonary contusions of the right pulmonary hemi-field and paramediastinal left upper lobe. Layer of bilateral pneumothorax with possible juxto-fissural pneumatocele of the upper part of the left fissure.Gravity-dependent parenchymatous compression of the posterior regions.Flail chest due to bilateral parasternal fractures of the anterior arches of the 3rd to 9th rib.

 

Abdominopelvic space:

Deep hepatic contusion of the junction of segments V and VII, in contact with the hepatic veins with no active bleeding. Liver fracture involving segments I and IV and reaching the hepatic hilum with no active bleeding. Moderately abundant hemoperitoneum, also present in the omental bursa.Right adrenal hematoma with moderate contact hemoretroperitoneum with no active bleeding.No other posttraumatic lesion in the abdominopelvic space (sequelar linear calcification of the splenic capsule).

 

Peripheral skeleton:

Comminuted open metaphyso-epiphyseal fracture of the inferior extremity of the right tibia (complete articular fracture, Association for Osteosynthesis classification C3). Comminuted, displaced overlapping fracture of the inferior third of the right fibular diaphysis. Talus intact.

 

N.B.: Supra and intercondylar fracture of the inferior extremity of the left femur evaluated with standard X-rays.


Diagnosis

Occipital Condyle Fracture, Thoracic injuries, Hepatic trauma, Adrenal hemorrhage


Discussion

FOLLOW-UP:

 

- Open reduction and osteosynthesis of the fractures of the right ankle and left knee.

- Monitoring of the liver fracture with CT check-up after 1 month unless a new clinical, hematological, or biochemical element arises.

- Monitoring of pulmonary contusions.- For the condyle fracture: immobilization with rigid neck brace for 3 months followed by CT check-up to be scheduled.

 

The subsequent follow-up report is not available, as the patient transferred to the hospital closest to his residence.


Key points

Important points:

 

- The C0-C1-C2 hinge is always analyzed in coronal reconstruction.

- Flail chest = at least 2 fracture lines on at least 3 adjacent ribs or fracture of at least 3 symmetric adjacent ribs in relation to the sternum.

- Pulmonary contusions = not confined to one lobe and present from the outset.

- Multi-plane and volume reconstructions provide useful information for the surgeon in the event of joint and/or complex and/or significantly displaced fractures of the peripheral skeleton.

 


References

IM05



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