Multi-Injury Trauma in Adolescent Boy
The team at Sacred Heart Medical Center's Level II Trauma Center uses a multidisciplinary approach to care for trauma patients in an eight-county region in western and southern Oregon.
Subject: Patient was a 17-year-old Roseburg boy who was riding a skateboard downhill at a high rate of speed when he lost control and hit a fire hydrant. Bystanders discovered him unresponsive at the scene. He was intubated and taken to Mercy Medical Center in Roseburg, where he was found to have a traumatic brain injury of unknown severity, a small pneumothorax, multiple sternal fractures, and a large, complex laceration of the anterior aspect of the left knee. He was transferred to Sacred Heart Medical Center at RiverBend, where he was brought to the intensive care unit.
Diagnosis: Trauma surgeon Travis Littman, MD, of Northwest Surgical Specialists handled the case. The patient suffered a severe concussion with a depressed Glasgow Coma Scale score of 6 at the scene and 15 by the time he was admitted to Sacred Heart (severe concussion). He had an open patellar fracture with a 20 cm laceration to the left thigh, significant chest trauma with suspected cardiac contusion, and a pneumothorax that was treated with a right-sided chest tube at Mercy.
Treatment: The patient was kept on a ventilator for two days due to cardiac abnormalities on his EKG and other indications of cardiac contusion. This was ultimately confirmed by echocardiogram. Serial echocardiograms continued to support this diagnosis. Sacred Heart cardiothoracic surgeon David Duke, MD, detected mitral valve regurgitation due to a partially torn leaflet. After careful study, it was determined that surgery was not appropriate at the time, but that the patient should be monitored over the coming months.
Upon the patient's initial arrival in ICU, Dr. Littman irrigated and closed the lower extremity laceration. Two days later, orthopedic surgeon Daniel Sheerin, MD, of Slocum Orthopedics performed an inferior pole patellectomy with advancement of the patellar tendon. The knee was locked in full extension until the wound healed, after which the patient began physical therapy. The patient was ambulating independently and his concussive symptoms had resolved prior to discharge on hospital day six.
Outcome: Several months later, the patient was doing well. He was attending school and playing basketball, despite some continued chest discomfort. His rib fractures appeared to be healing. He continued to have moderate tricuspid insufficiency, although the valve was functioning better than it had been immediately after the accident. He remained under the care of a cardiologist, and was advised that if his injuries caused discomfort or limited his activities in the future, surgical repair was remains an option.