Management of a Polytrauma Case In a Resource-Constrained Hospital

Abstract

Introduction: The management of polytrauma patient should be beforehand and always in keeping in mind the damage control. the surgical treatment is secondary to the stabilization of the patient. Clinical Case: we are reporting a 34 years old polytrauma patient from a motor vehicle accident. On physical examination, we noted : a severe brain injury, a closed articular fracture of right distal radius associated to a dislocation of distal radius and ulna distal joint, a closed bilateral fracture of both trochanters, an open communitive tibial fracture of proximal epiphysis methaphysis and diaphysis. The last one was classified as type IIIB of Gustilo and Anderson and associated to a closed fracture of the head and the neck of right fibula, a closed fracture of the right lateral malleolus. After patient stabilization, the head injury improves to normal Glasgow score on 8th day of admission. Necrosis of soft tissus and exposition of the tibia was noted. The surgical treatment was done on 2 stages due to financial issues. A bone synthesis of the trochanteric fracture was done only on the left and external frame as well as a muscle flap was done for the right tibial fracture on the 18th day. On the 42nd day a PAPINEAU technic associated to a proximal inter tibiofibular graft was done. The functional outcome of the orthopaedic treatment of the wrist was bad (malunion). That last complication was managed by a SAUVE KAPANDJI surgery (at 6 months) and the contracture (pronation and supination) at 12 months post trauma. The outcome was fair good despite patient financial issue and local complications that compromise an optimal surgical management and a delay. He resumes normal professional activities at about 2 years. At 5 years follow up, functional and anatomical results were satisfactory. Conclusion: In a limited ressources’ setting, the management of lesions including a multiple fractures is a challenge for the practitioner and the injuried patient. A management taking into account social and economic ressources is mandatory to minimise sequelae. Keywords: Management, Polytrauma, Limited ressources.