PP 84 ‘DISARMED’ AMPUTATED FOREARM AT THE ELBOW JOINT

Abstract

INTRODUCTION

We present a rare trauma case in which the whole forearm was amputated from a motorvehicle accident but could be reattached with expedient emergency medical response by multiple teams.

CASE REPORT

A 32 years old gentleman had an alleged history of fall of his motorcycle. As he fell, his left elbow was cut through and through by a telephone cable by the roadside. The whole forearm was amputated. He was brought to the hospital via an ambulance and arrived along with the limb. On arrival, his GCS was full. The BP was 142/88, HR 101 bpm and SPO2 97% on air. No active bleeding was noted over his elbow stump. Fluid was started, anitetanus toxoid administered and analgesia in the form of morphine 5 mg was given. Pain was well controlled. Wound irrigation was performed on the stump. Wound irrigation was also performed using normal saline on the segregated forerm. It was then wrapped in a plastic and placed in plastic filled with ice and kept in an ice-box. The orthopaedics team was called in. Patient was sent to the operation theatre in the attempt of limb reattachment. Unfortunatey, the procedure failed and stump refashioning was performed.

DISCUSSION & CONCLUSION

Preserve limbs with double layered iced plastic bag. Wound irrigation is essential to ensure contaminants are removed early to avoid infection post-surgery. With a bit of luck, amputated forearm may be reattached with patient surgical repair work. Unfortunately, this procedure failed. Pre-procedure counseling is essential to prepare patient’s mind.