Abstract
A 29-year-old male patient, who was injured in a motor vehicle accident, was hemodynamically unstable, and lost consciousness. X-rays and computed tomographies revealed fractures of the odontoid process, a right hemopneumothorax, injuries to the liver, spleen, and right kidney, and open fractures of the bilateral femoral shaft (ISS 50). A transarterial embolism (TAE) was performed for the abdominal hemorrhage, and external fixations were undertaken to temporarily stabilize the femoral fractures. Resuscitation and treatment of the subsequent complications- ARDS, DIC, and acute renal failure- were provided in the intensive care unit. MRI revealed cervical spinal cord injury. For the definitive fixation, a Magerl and Brooks' operation on the odontoid process fracture was performed six days after admission, and the internal fixation of the bilateral femoral fractures using Ender nails were performed on the 21st day after admission. The patient's general status did not deteriorate before and after these operations, and the timing of these definitive operations was optimal. The abdominal organ injuries, tetraplesia, and the femoral fractures improved gradually, and the patient was discharged on crutches five months later. The concepts of damage control orthopedics are essential in improving the clinical outcome and decreasing the mortality of such severely traumatized patients.
