A 43-year-old woman is airlifted to your facility from an outlying area following a severe motor vehicle collision. Details are unclear, but there were known fatalities at the scene. Her primary complaints are abdominal pain and noted deformities of the lower extremities, according to the transporting medical personnel.
On arrival, she is noted to be semi-arousable and is moving distal portions of all four extremities. Her heart rate is 150 beats/min, with a blood pressure of 80/40 mm Hg. She responds to initial fluid and volume resuscitation. She has no pertinent medical history.
Her response to the fluid resuscitation is sufficient to stabilize her for transport to the CT scanner for additional imaging. Prior to the transfer, though, a portable radiograph of her right tibia is obtained. What is your impression?
ANSWER
The radiograph shows a comminuted fracture at the midshaft of the tibia. In addition, there is a comminuted fracture of the proximal tibial metaphysis extending to the tibia plateau. Also noted is a comminuted fracture of the distal femur metaphysis extending to the intercondylar notch.
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