Ranjeet Shil, 38 year old labourer from Kolkata, had sustained accident in his company with a cement mixer truck running over his rt.leg on 1st Nov 2018. Patient’s leg was crushed under the truck and the pt. was taken to nearby local hospital for emergency management. Pt. was diagnosed there with complex fracture of rt.thigh bone with complete tear of Popliteal artery which is the major blood supply of the leg.
Patient was operated in emergency with temporary fracture fixation and blood vessel repair in Local Hospital, Mira Road. Unfortunately, patients general condition deteriorated after the operation, his BP shot down, Heart rate increased and early kidney failure with nil urine output were noticed and his condition worsened. Patient was immediately transferred to Wockhardt Hospital, Mira Road in this critical condition on 3rd Nov. He was admitted in ICU. On admission, pt.’s general condition was poor and critical with nil urine output. Patient was diagnosed with acute kidney and liver failure because of systemic spread of toxins from rt.leg injury. After analysis the critical situation, the decision to amputate his rt.leg as a lifesaving procedure was also to be considered. Saving the life was always the priority but considering the fact of his young age and he being the sole bread winner for his family, we as a team decided to save his limb if possible.
Dr. Nikhil Agarwal , Orthopedic Consultant & Surgeon from Wockhardt Hospital, Mira Road said, “After multiple blood transfusions, dialysis and other resuscitative measures, we 1st stabilized his general conditions and saved his life & then our entire focus was to save his leg and avoid amputation. On day 3 of his admission, the rt.leg wounds were cleaned thoroughly and all the measures for prevent infection in the leg and body were taken with simultaneously controlling the liver & kidney functions. On day 10th, all the clean wounds were covered with plastic surgery. Unfortunately after few days, minimal infection occurred near the fracture which again was treated with thorough cleaning and other supportive measures.
During the course of treatment, pt’s kidney function improved and liver recovered well too. Pt’s general condition was quite stable with the systemic and rt.leg local infection under control. Finally, after 3 weeks of admission and rigorous medical and surgical management, pt’s fracture was fixed with rod and bone grafts on 24/12/18. After the operation, the patient could stand and walk immediately and at end of 2 months in hospital, patient completely recovered, Kidney, liver function were normalised and his rt.leg survived.