Management of a Polytrauma Patient with L4 Bony Fracture-Dislocation, Multi-Level L1-L3 Flexion-Distraction (Bony Chance) Injuries, Lateral Compression III Pelvic Injury, and Lower Extremity Fractures

Abstract

This is the first documented case of a neurologically impaired polytrauma patient with multiple bony Chance injuries, a windswept pelvis, and lower extremity fractures. The patient was a male miner in his mid-30s who incurred multiple injuries in his lower extremities and spine. He initially consulted at a secondary care facility but transferred hospitals for further management. The index surgery was done four days post-injury (beyond 72 hours) and included open reduction, stabilization of the affected spinal segments with pedicle screws/rods from the lumbar spine to both sacroiliac joints. The patient was discharged after having to undergo debridement for a surgical site infection of the spine, and definitive fixation of the right femur and left tibial plateau. At one year follow-up, the patient was ambulatory without assistance without other complications. In dealing with polytrauma patients with multiple spinal, pelvic, and lower extremity fractures, early treatment is recommended to prevent future complications.

Keywords

• polytrauma
• chance fracture
• fracture dislocation
• flexion distraction
• spine