Agricultural Rotavator Induced Polytrauma in a 11-years-old Child – A Case Report

Abstract

Introduction: Agricultural polytrauma injuries in children are rare. Rotating blades of a tractor can cause devastating injuries. Case Report: An 11-year-old male child presented with severe facial avulsion injuries, degloving injury of left lower limb, grade IIIB compound left tibia shaft fracture with a large butterfly fragment, and closed right tibia shaft fracture. General anesthesia through tracheostomy intubation was given. Simultaneous surgical intervention for the face and limbs was performed by a team of experts. The facial injury was debrided and repaired. After thorough debridement, compound left tibia fracture fixation was performed with two interfragmentary screws and neutralizing ankle-spanning external fixator. The closed right tibia shaft fracture was treated with closed elastic intramedullary nailing. Simultaneous debridement of degloving injuries over both thighs was performed and wound closure was done. Subsequently, the patient underwent debridement of wounds and vacuum-assisted closure 3 times with split skin grafting for the left leg. All fractures healed well at 6 months and the child was able to do all activities without any functional limitations. Conclusion: Agricultural injuries in Children can be devastating and should be managed using a multidisciplinary approach at a tertiary care center. A tracheostomy is a viable option for securing the airway in severe facial avulsion injuries. In a hemodynamically stable child, definitive fixation can be performed in a polytrauma situation and an external fixator can be used as a definitive implant in an open long bone fracture. Keywords: Agricultural injury, compound fracture, external fixation, facial avulsion injury, orthoplastic approach, pediatric polytrauma.