In the world of medicine, you never know what you’ll encounter, especially in an emergency department. Here are the top five most interesting real-world medical cases of traumatic injury trending on Figure 1.
#5. Open Distal Femur Fracture
An orthopedic surgeon shared this case of a G-A IIIA open distal femur fracture. The patient sustained the traumatic injury “after landing on leg and hyperextending knee off of motorcycle at 80mph. NVI. Popliteal artery tented over distal femur, fragment kicked 90 degrees.”
The community jumped in with recommendations for management, including from an orthopedic surgery resident, who said, “ABC assessment. High chance of secondary injury. Specifically for this fracture: immediate broad spec antibiotics, tetanus. Straight to theatre for washout and spanning ex fix. I would have vascular with me just in case. Will need second look and CT. May be suitable for distal femoral LCP as definitive management but would need more info. Leave the fibula.” An orthopedic surgeon followed up on this recommendation, adding, “Don’t overlook ankle injury with proximal fibula fracture.”
How would you manage this case? See the full image and add your recommendation
#4. Screwdriver Impaled in Knee
This image, shared by a pediatric radiology team, is of a “lateral … radiograph of the knee in a child who fell on a screwdriver” and “shows the tool lodged within the soft tissue of the anterior knee.”
Per the author of this post, “radiographs are used in foreign body trauma such as in this patient to determine the relationship of the foreign body to adjacent bone and soft tissue structures.”
An emergency medicine technician added this cautionary note, “Seems to have missed most of the important stuff, but I’m very mildly concerned for the joint capsule. The way it went in is not necessarily represented by where it came to rest.”
#3. Degloving Following Traumatic Injury
The third most interesting traumatic injury involves a patient who was hit by a bus and subsequently experienced degloving of the forearm. The licensed practical nurse who shared this case followed up that the patient received surgical care and skin grafting to treat the injury.
#2. Shattered Spleen
A surgeon posted this case of a 16-year-old who was involved in a traffic accident that caused the spleen to shatter from blunt force trauma. The surgeon shared this pearl of wisdom for postoperative care: “Postoperative vaccination for encapsulated organism is necessary in such cases” to reduce the risk of post-splenectomy sepsis.
Have any pearls of wisdom to add?
#1. Spinal Injury
And the top most interesting traumatic injury case involves a patient who experienced blunt force trauma to the abdomen from a tree during a logging accident. According to the technician who shared the case and CT spine images, surprisingly the patient experienced only “back pain lumbar level only, no loss of sensation in the legs, no loss of mobility of the legs.”
A physiotherapist assistant commented in response to the patient’s status, “Wow that’s amazing that he didn’t lose any abilities looks like his cord should be splinched.”
Published May 2, 2023
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