CRITICAL THROMBOTIC COMPLICATIONS IN PATIENTS WITH MASSIVE POLYTRAUMA: ANALYSIS OF A CLINICAL CASE

Abstract

Trauma is a leading cause of death and disability among the working-age population, resulting in more than 5 million deaths annually. Trauma-induced coagulopathy (TIC) develops as a result of combined tissue injury and shock, leading to complex disturbances in hemostasis. Goal. To present a clinical case of acute arterial thrombosis and subsequent lower limb amputation in a patient with polytrauma and to evaluate the importance of early hemostasis monitoring. Materials and Methods. The patient was admitted in critical condition after a crane boom fell onto the lower limb girdle, predominantly on the right side, with the limb compressed for approximately 15 minutes. Upon admission, the following diagnosis was established: rotationally unstable pelvic fracture; fracture of the right sacral lateral masses; fractures of the right iliac, pubic, and ischial bones, and the left pubic bone; closed fracture of the proximal epimetaphysis of the left femur; Grade I open comminuted fracture of the middle third of the left femur with fragment displacement; traumatic shock of Grade II–III. All necessary diagnostic procedures were performed, including ultrasound, radiography, and MSCT. Emergency stabilization of all fractures was carried out with the placement of external fixation. Antibacterial therapy, infusion therapy, and analgesia were initiated. Thrombosis prophylaxis with enoxaparin was started 12 hours after admission. Result. Despite the treatment provided, acute arterial thrombosis of the right lower limb occurred on the third day. Urgent contrast-enhanced CT revealed an acute occlusive post-traumatic arterial thrombosis at the level of the mid-thigh on the left side. Following a multidisciplinary consultation, a decision was made to perform limb amputation for vital indications. Conclusions. This case demonstrates that in patients with polytrauma accompanied by soft tissue compression, extensive fractures of multiple long and cancellous bones, and blood transfusion therapy, more frequent ultrasound monitoring of the lower limbs and daily thromboelastography are necessary for the preventive diagnosis of thrombosis and timely adjustment of antithrombotic therapy.