Title: Crash prone motorcyclist: Noncontiguous double-level thoracic spine fracture dislocation with complete paraplegia
Abstract:
Introduction: Crash prone individuals are those who had recurring crashes more than expected and those with floating thoracic spine injury has never been reported. Case Description: A 36-year-old male with a history of head injury and left femur fracture following first and second motor vehicle accident respectively had his third accident presenting with breathing difficulty, back pain, and paraplegia. Initial neurology revealed muscle strength of MRC 0, hypotonia, hyporeflexia and sensory loss from T4 downwards. He was intubated for respiratory distress and GCS of 12. Bilateral chest tube inserted for bilateral hemopneumothorax, multiple ribs fracture and lung contusion. CT scan showed T4/T5 bilateral locked facet with anterior dislocation of T4 over T5 and Chance fractures of T8 and T9, locked T8/T9 facet with anterior dislocation of T8 over T9. He also had bilateral acute subdural hemorrhage with cerebral edema, nasal bone, nasal septum, left maxilla and bilateral parietal skull fractures. Posterior instrumentation, reduction of dislocation and fusion was done with 12 pedicle screws from T3 to T11. Postoperatively, T4 and T5 sensory improved slightly but the motor strength remain the same (ASIA A). He had major depression with abnormal behavior, poor family support and noncompliant to rehabilitation leading to bedridden complications and death after 3 months of surgery. Conclusion: Road traffic regulations and policies may focus more on the likelihood of future crashes on crash-prone drivers and its impact. A holistic biopsychosocial approach and evaluation in accident prone patients with polytrauma is paramount to achieve a positive outcome.
Biography:
Wan Zainuddin WAR has completed his Master in Orthopaedic Surgery at University Science of Malaysia in 2016 and now completing his Fellowship in Spine Surgery at National Center of Spinal Disorders Budapest, Hungary. He serves as an Orthoapedic and spine surgeon in Hospital Sultan Ismail Johor Bahru, Malaysia. He is the reviewer for The Spine Journal (TSJ) and has published in few journals.
