kolkata: Narayana Hospital, RN Tagore Hospital, Mukundapur continues to set new benchmarks in critical trauma care with the successful treatment of a 20-year-old male patient, Mr. Gaurav Jain (name withheld for privacy), who suffered multiple fractures following a fall from height. This complex orthopedic case, handled by the experienced team at Narayana Hospital, RN Tagore Hospital, Mukundapur, represents a shining example of Early Appropriate Care (EAC) in trauma surgery, ensuring rapid recovery and minimizing complications.
Mr. Jain was brought to Narayana Hospital, RN Tagore Hospital, Mukundapur, after falling from a significant height, resulting in trauma to both his ankles, right leg, lower back, and head. He was quickly admitted to \the Emergency Room (ER) with symptoms of pain, swelling, and an inability to bear weight on his ankles, both of which showed clear signs of bony deformity.
Upon arrival, the patient’s vital signs were stable, with a Glasgow Coma Scale (GCS) score of 12/15, but he exhibited confusion and was responsive only to stimuli. Initial local examinations revealed a scalp injury, swelling in the lower back, and extensive damage to both ankles, including open wounds on the left ankle, exposing bone fragments.
The medical team promptly initiated resuscitation and carried out comprehensive diagnostics, including a CT brain scan and trauma series radiography (X-rays). These evaluations revealed several significant injuries: fractures of the right medial and lateral malleolus with tibial extension at the syndesmotic area, fractures of the left medial and lateral malleolus, and a compression fracture of the L3 vertebrae. Additionally, the CT scan indicated the presence of traumatic subarachnoid hemorrhage and a small subdural hematoma.
Led by Dr. Surya Udai Singh ,Senior Consultant of Orthopaedics & Robotic Knee Replacement, explained, and Dr. S. Sanyal, Senior Consultant in Neurosurgery, the medical team made the critical decision to proceed with Open Reduction and Internal Fixation (ORIF) of both ankles on 28th May 2024. The surgery involved reducing the fractures and stabilizing both ankles with plates, screws, and syndesmotic screws to ensure the long-term structural integrity of the ankle joints.
“Treating a case of bilateral ankle fractures is a challenge due to the complex ligamentous structures around the ankle joint, which are responsible for weight-bearing and mobility,” said Dr. Surya Udai Singh. “In this particular case, timely intervention was critical to ensure the best possible outcome, and we are pleased that the patient responded so well to treatment. Our team meticulously balanced the need for immediate surgical care with the patient’s overall health and stability.”
The surgery took approximately 4 hours and included debridement of the open wound on the left ankle to prevent infection. The patient was also placed under conservative management for his L3 vertebral fracture, which included rest and the application of a lumbosacral belt for spinal support.
Mr. Jain’s post-operative period was uneventful. He spent one day in the Intensive Care Unit (ICU) for close monitoring before being transferred to the general ward. The medical team provided regular dressing changes and initiated early mobilization exercises, including active toe movements to prevent stiffness.
This case is a testament to the importance of Early Appropriate Care (EAC) in trauma surgery. In situations where orthopedic surgeons must choose between Early Total Care (ETC) and Damage Control Orthopedics (DCO), the Narayana Hospital, RN Tagore Hospital, Mukundapur team opted for EAC, providing definitive surgical intervention after ensuring the patient’s stability. This approach not only reduced the risk of complications like hospital-acquired infections and post-operative psychosis but also ensured early discharge and a quicker return to normal life.
Mr. R. Venkatesh, Group COO of Narayana Health, remarked, “This case demonstrates the expertise and dedication of our team. Narayana Hospital, RN Tagore Hospital, Mukundapur continues to lead in providing world-class care for complex trauma cases.”
During surgery, the team encountered several challenges, primarily due to the significant ligamentous damage around both ankles, leading to instability. Fixing each fracture fragment while preserving soft tissues and ensuring ligamentous balance was crucial. Additionally, the open wound on the left ankle required careful management to prevent infection. The use of a below-knee slab and antiseptic dressing helped maintain joint stability and promote healing.
Mr. Abhijit CP, Director, Narayana Hospital RN Tagore Hospital, and Corporate Growth Initiatives, Narayana Health (East), highlighted the importance of Early Appropriate Care (EAC), noting, “Our team balanced early intervention with patient safety, avoiding complications and ensuring a smooth discharge.”
Mr. Gaurav Jain is now undergoing outpatient rehabilitation and is expected to make a full recovery.
