Polytrauma management requires a multidisciplinary team approach to ensure optimal patient outcomes. Timely, prioritized, and coordinated interventions play a crucial role in reducing morbidity and mortality, expediting recovery, and restoring function. We present the case of a 33-year-old female with life-threatening thoracic, abdominal, orthopedic, and soft tissue injuries following a road traffic accident. Staged and coordinated interventions across specialties, including cardiothoracic surgery, general surgery, orthopedics, and plastic surgery, were essential for her survival and recovery.
A 33-year-old female was involved in a road traffic accident and sustained injuries to her left hip, thigh, foot, chest, and abdomen. She initially received first aid at another hospital and was subsequently referred to our center for advanced management.
On evaluation, her Glasgow Coma Scale (GCS) score was E1VTM1. The airway was secured with mechanical ventilation, and she required noradrenaline infusion for hemodynamic stabilization. Initial emergency resuscitation was carried out in the emergency department.
Bedside chest X-ray revealed a left-sided tension pneumothorax, for which the cardiothoracic surgery (CTVS) team immediately performed emergency intercostal drain (ICD) insertion under sterile precautions. This promptly relieved intrathoracic pressure.
A pan-CT scan revealed:
Given the abdominal findings, the patient underwent emergency laparotomy with splenectomy. The humeral and sacral fractures were managed conservatively.
On the third post-trauma day, after anesthetic clearance, retrograde intramedullary nailing of the left femoral shaft fracture was performed. Simultaneously, the plastic surgery team addressed extensive soft tissue injuries of the left foot and ankle. Intraoperative findings included complete heel pad avulsion with circumferential degloving injury, extensor digitorum longus tendon injuries to the 2nd and 3rd toes, and transection of the dorsalis pedis artery.
Thorough debridement and tendon repair were performed, while the transected artery was ligated. A below-knee posterior plaster slab was applied for immobilization.
On the seventh postoperative day, fixation of the complex acetabular fracture was undertaken. Using O-arm guidance, malleolar and cannulated screws were placed to stabilize the anterior and posterior columns, along with additional plating for anterior column reinforcement.
Symptomatic improvement was noted. The patient’s GCS recovered to 15/15, and she commenced bedside physiotherapy, progressing toward recovery.
This case underscores the importance of early recognition and treatment of life-threatening thoracic injuries in polytrauma. Prompt identification of tension pneumothorax and immediate ICD placement by the CTVS team were pivotal in preventing cardiopulmonary collapse. Timely hemodynamic stabilization, life-saving laparotomy, and staged fracture fixation were equally critical to survival and recovery.
Retrograde intramedullary nailing was selected for the femoral shaft fracture due to its minimally invasive approach, superior mechanical stability, and facilitation of early mobilization—attributes that are particularly advantageous in polytrauma settings.
The necessity of a multidisciplinary approach in this case was evident, with cardiothoracic, general surgery, orthopedic and plastic surgery teams working in close coordination. This allowed simultaneous procedures, minimized surgical burden, and optimized outcomes.
Polytrauma involving thoracic, abdominal, orthopedic and severe soft tissue injuries requires rapid diagnosis, prioritized interventions, and staged multidisciplinary management. Early thoracic decompression, prompt laparotomy for intra-abdominal injuries, fracture stabilization, and soft tissue reconstruction are vital for improving survival and long-term outcomes. Retrograde intramedullary nailing remains an excellent option for femoral shaft fractures in polytrauma, balancing mechanical stability with minimal additional insult.
Dr. Aarif Raja 2nd Year Resident Kauvery Hospital, Chennai.
