Abstract
A 70-year-old man was brought in semi-comatose 30 minutes after being hit by a motorcycle. The blood pressure was 60/40 mmHg. The pupils were isocoric and light reflex was noted. The face was markedly swollen by massive bleeding. Open fracture of the left leg was also present. Intratracheal intubation was immediately performed and 10, 000 ml of blood and fluid were administrated. X-ray films showed fractures of the nasal bone, the zygomatic bones, the zygomatic arches, the orbitae, the maxilla, and the mandibula. Fractures of the iliac bone, the left tibia and fibula were also noted, but no signs of abdominal and vertebral injuries were present. Computed tomography (CT) showed a slight cerebral contusion. Epistaxis was controlled by Brighton balloons, but bleeding from other portions continued. To maintain hemodynamics, reduction and fixation of the facial bones by a halo-external fixation apparatus were performed. Intramedullary nailing of the leg was also done. Cerebral contusion was treated conservatively. One year after the accident, he can walk and live a comfortable life without severe malformations.
In craniofacial injuries, bleeding is sometimes massive and uncontrollable. In this case, the haloexternal fixation controlled the bleeding perfectly. This apparatus is very compact and has a high degree of flexibility in various situations. Because the metal frame disturbs CT scanning, intracranial pressure monitoring is essential when intracranial lesions are suspected.
