Click on images to view radiographs and clinical pictures.
A 35 year old man was riding his motorcycle
at 60km/hr when he was T-boned from the left by a car travelling
at the same speed. He was brought to your trauma room and
the ATLS protocol was initiated. His airway is patent, he is
conscious and hemodynamically stable. There are obvious
extremity deformities and radiographs are taken in the trauma
room. His C-spine is cleared both clinically and
radiographically. The secondary survey is performed and he
has only orthopaedic injuries:
Right Ankle - No Dorsalis Pedis pulse, 6cm
soft tissue wound with visible deformity
Left Humerus - Neurovascularly intact but
tender over olecranon
Left Distal Radius - Tender and deformed
Right Distal Radius - Tender and deformed
ATLS protocol was followed and the airway
was patent. 100% Oxygen was given via non-rebreather mask, 2
large bore IVs were instituted with Ringer's
Lactate. The C-spine was immobilized in a semirigid
cervical collar and then later cleared clinically and
radiographically. The patient was hemodynamically stable
and there were no neurological injuries thanks to the helmet
which was removed by the paramedics. Our management
was as follows:
Right Ankle - Closed reduction in the
trauma room was performed and the Dorsalis Pedis pulse
returned. Tetanus Toxoid 0.5cc IM and Cefazolin IV 1g was
The patient was taken to the operating room
for Irrigation and Debridement plus Open Reduction and Internal
Fixation of all fractures.
I&D plus ORIF of the Right Ankle using
two medial screws and tension banding of the lateral malleolus:
The left distal radius still did not have
absolute stability so two mini fragment lag screws were used in
addition to the ulnar plate and radial external fixator:
The right distal radius fracture was treated with an external
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