How to treat my friend's shoulder and rib fracture?

Question

Hi doctor,

My friend is a 40-year-old female. She met with an accident before 10 days. Her arms and shoulders got fractured. Her ribs too got injured. She is having chest pain, breathing problem and clot in blood vein. I have attached all her CT scan and X-ray reports with this.

Please advise what treatment is required.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

As per the reports (attachment removed to protect patient's identity) submitted, I understand that it was a major accident. She has multiple injuries to various parts. Usually, with such injuries, it is difficult to isolate each problem and provide a solution without seeing the patient, as multiple organs are involved.

As it has been 10 days since her accident, I assume that she is clinically stable, by which I mean that her pulse rate and blood pressure are normal or near normal.

Both the bones are fractured in her arm. So, an internal fixation (installing a plate) done by operation would be ideal. For the shoulder, I cannot make out any fracture that needs surgery. Anything minor can be managed by support and strapping for the clavicle.

Chest pain and breathing problems will be there due to multiple rib fractures. CT suggests minimal blood in the thorax. She will require chest tubes (which might already have been put in) on both sides, but the decision is clinically based.

High-dose analgesics (painkillers) will be required for the pain, to help her breathe. Also, she may require ventilatory support for some time as she may not be able to breathe well due to the pain.

I could not see any report suggesting a blood clot in the veins, whether it is in the upper limbs or lower limbs. If it is associated with the fracture in the upper limb, then the best treatment is surgical removal during fracture fixation.

Lower limb clot also may need surgery based on the extent of involvement, and it is a clinical decision. It is usually done at the earliest. As it has already been 10 days since the accident, I do not understand which clot they are talking about.

Remaining supportive care is going on as required, as you have written. Her last hemoglobin was 8.3. I believe she was given blood transfusions after that. If not, she needs a blood transfusion, too.

I hope this information is helpful.

Please do not hesitate to contact me if you need to know anything else; I would be happy to answer.

Thank you.

Answer 2

Hi,

Welcome back to icliniq.com.

I think she still needs some treatment. If she is stable, she can be shifted, but will need to be shifted in an ambulance with precautionary measures. She will require hospital care for a longer time, which can be obtained at her place, too.

No, chest pain and breathing problems are due to the rib fractures. If there were blood in the chest, the doctor would have put in chest tubes, which help improve breathing.

There is a small controlled tear in the aorta (the blood vessel supplying all parts of the body), which may require monitoring now and assessment at a later date to determine whether surgery is necessary.

I hope this information is helpful.

Please do not hesitate to contact me if you need to know anything else; I would be happy to answer.

Thank you.