Early total care in polytrauma patient with floating shoulder and occlusion of bilateral subclavian artery: A case report

INTRODUCTION: Fracture in polytrauma patients have higher risk of morbidity and mortality compared to those found in monotrauma patients. The ideal approach of orthopaedic injuries is to perform definitive fixation of all fractures in one single procedure, an approach known as Early Total Care (ETC). PRESENTATION OF CASE: A patient presented with history of being struck by heavy material forklift. He complained of pain in the shoulder and difficulty in breathing. The patient was diagnosed with polytrauma ISS Score 25, which consists of floating shoulder, closed fracture of multiple ribs, open hematopneumothorax, and thrombosis of subclavian artery. The following procedures were performed: debridement, ORIF plate and screw of right clavicle, ORIF lag screw of right glenoid scapula, thoracotomy segmental lobectomy, bypass of bilateral carotid artery to bilateral brachial artery. DISCUSSION: An early surgical treatment is paramount in the management of this patient, with the aim of restoring the joint and blood flow to the distal part of the hand, which will allow for early motion and more effective physiotherapy for the patient’srecovery. Early definitive fracture fixation in ETC in recommended in for stable patients and those who falls under the category of borderline and unstable patients who responds well to resuscitation. ETC allows for early mobilization and therapies for the patient. CONCLUSION: Early total care is an appropriate choice of treatment for polytrauma patients presenting with floating shoulder.