Multiple Trauma MVA
By Riley Timmins
Introduction
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29 year old male in single car MVA
Patient air-lifted to Good Samaritan Regional
Medical Center.
Pt. was stable but unconscious on arrival.
Pt. presented with multiple fractures and
abdominal injuries.
ER Dr. ordered a portable CXR and
head/neck/chest/abdomen/pelvic CT’s
Portable AP Chest X-ray
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Film done supine on
backboard
14X17 cassette cross-wise
125 kVp @ 6.4 mAs
w/grid @ 50 inches
Axial CT Chest Slice
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This slice is showing the
lungs and the heart in the
center.
The slice also shows
atelectasis which is the
partial collapse of a lung
due to a blockage of the
airway.
Axial CT Abdomen Slice
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This slice shows the liver
of the patient and the
arrows indicate
contusions.
Axial CT Abdomen/Chest Slice
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This is another
contusion of the upper
portion of the liver.
Coronal CT Slice
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This slice shows the liver
on the right and the
spleen on the left.
Notice the smooth
borders of both the liver
and the spleen.
Coronal CT Slice
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The lower margin of the
spleen in this slide has
become disrupted and is
rough in appearance.
Coronal CT Slice
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This next slide shows
this even more so.
Coronal CT Slice
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This is indicative of a
macerated spleen. This
basically means that the
tissue has been shredded.
Axial CT Abdomen Slice
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This is just another view
of that gives a different
view of the macerated
spleen.
Axial CT Abdomen Slice
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In this slice, the
Mesenteric vasculature is
visualized and a bleed
can be seen.
Coronal CT Abdomen Slice
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This is a few of the same
bleed just from another
view.
Coronal CT Abdomen Slice
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In this Slice, free blood is
demonstrated, indicating
a hemoperitoneum.
Axial CT Pelvic Slice
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Again, a
hemoperitoneum is
demonstrated.
Axial CT Pelvic Slice
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This slice demonstrates a
fracture of the right
pubic rami.
Axial CT Pelvic Slice
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The pubic rami fracture
is demonstrated again
here.
Axial CT Pelvic Slice
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The fracture of the left
proximal femur is
demonstrated here.
Axial CT Pelvic Slice
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A fracture of the
acetabulum is visible
here.
Axial CT Pelvic Slice
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Another fracture is
visible here in the roof
of the acetabulum.
AP Right Tib/Fib X-ray
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14x17 film corner to corner.
65 kVp @ 3.2 mAs, non-grid
@ 40 inches.
Film should include both
knee and ankle joints. Lateral
and medial malleoli are
clipped.
Fractures of the fibular head
and mid fibula and tibia.
Lateral Right Tib/Fib X-ray
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14X17 Film corner to corner,
cross-table
65 kVp @ 3.2 mAs, non-grid
@40 inches
Film should include both
joints but proximal tibia is
clipped.
Fractures of the fibular head,
mid-fibular and tibial shaft,
and the calcaneus.
AP Left Tib/Fib X-ray
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Same technique as the
right tib/fib.
Comminuted fracture of
the tibial plateau,
proximal shaft of both
the tibia and fibula.
Lateral malleolus is
clipped.
Lateral Left Tib/Fib X-ray
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Same technique as right
tib/fib.
External fixation
apparatus is
superimposed over
pertinent anatomy.
Both proximal and distal
tib/fib are clipped.
Lateral Left Knee X-ray
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10X12 film used
lengthwise to the part,
cross-table
65 kVp @ 4 mAs, nongrid @ 40 inches.
Knee joint is visualized
but rotated.
Tibial Plateau fracture is
demonstrated as is a
femoral fracture.
AP Left Knee X-ray
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Same technique as used
for the lateral.
Tibial plateau fracture is
demonstrated as is
another fracture on the
medial epicondyle of the
femur.
AP Left Femur X-ray
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14X17 film, lengthwise.
68 kVp @ 5 mAs, non-grid
@ 40 inches.
Femur film should include
knee joint to the acetabulum
of the hip joint. Two films
must be taken to achieve this.
Dr. only wanted what was
necessary.
Spiral type femoral fracture is
demonstrated
Lateral Left Femur X-ray
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14X17 film lengthwise,
cross-table.
Same technique as AP
Dr. deemed this was
sufficient and didn’t
request upper films.
Lateral Right Femur X-ray
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Same film and technique
configuration as Left
Femur.
No fractures or
abnormalities in the
femur.
Fibular head fracture is
demonstrated.
AP Right Femur X-ray
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No fractures of the
femur demonstrated.
AP Left Hip X-ray
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14X17 film lengthwise
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GRID?
AP Pelvis X-ray
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14X17 film, crosswise
80 kVp @ 100 mAs, with
a grid @ 50 inches.
Pelvis film should
include the entire ischial
tuberosity. It is clipped in
this film.
There is a right superior
pubic ramus fracture
demonstrated.
AP Left Forearm X-ray
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14X17 film, corner to
corner.
62 kVp @ 2.5 mAs, nongrid @ 40 inches.
Should include both
wrist and elbow joints.
Mid-shaft fracture of the
ulna is demonstrated.
Lateral Left Forearm X-ray
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14X17 film is used
lengthwise.
Same technique as AP
Ulnar fracture is
demonstrated
Post-Op AP Left Femur X-ray
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External fixator has not
brought fracture into
alignment much.
Post-Op Lateral Right Tib/Fib
Post-Op AP Right Tib/Fib
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External fixators in place
Post-Op Lateral Left Tib/Fib
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External fixators in place
Post-Op AP Left Tib/Fib
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External Fixators
Post-Op Lateral Right Ankle
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External Fixators
Post-Op AP Right Ankle
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Only external fixators
were used probably due
to the severity of his
abdominal injuries.
I think the priority was
just stabilization.