Insidious, deadly, common - polytrauma with pelvic fracture

Abstract

Polytrauma patients with pelvic injuries have a high mortality rate, particularly in those who are haemodynamically unstable, reaching up to 42%. This case study involves a 66-year-old cyclist struck by a tram in Gdańsk, Poland in October 2022. Upon arrival at the Emergency Department of the Medical University of Gdańsk, the patient exhibited stability but later entered the initial shock phase. Comprehensive imaging unveiled flail chest, bilateral pneumothorax, spinal fractures, and an unstable pelvis. Despite a negative point-of-care ultrasound, the planned orthopaedic pelvic stabilization surgery transitioned to endovascular intervention due to deteriorating shock and suspected retroperitoneal bleeding. Despite a successful procedure, the patient succumbed to irreversible shock and multiple organ failure the next day in the intensive care unit. The significance of rapid identification of internal bleeding followed by timely endovascular intervention and retroperitoneal pelvic packing is underscored, as it has demonstrated decreased mortality in similar cases.