Successful macro-replantation of traumatic upper extremity amputation and type C-spinal cord injury with good functional recovery - a case report.

Abstract

<h4>Introduction</h4>Traumatic amputation and unstable spine injury both require timely interventions to achieve best outcome. A young polytrauma patient with upper extremity amputation and spinal cord injury is presented. The patient underwent macro-replantation of the upper extremity and spinal canal decompression and dorsal stabilization.<h4>Case presentation</h4>A male patient sustained polytrauma from a train accident with traumatic amputation of the right forearm. Diagnostic work-up revealed severe thoracic injuries and an open translocation injury type C L1/L2. The morphology was suggestive of complete paraplegia resulting in wheelchair-dependency. After initial treatment according to ATLS™ guidelines, replantation of the upper extremity was achieved within 5 h. A 30-degree elbow arthrodesis was established for future wheelchair mobility. Spinal cord injuries were addressed using dorsal spinal stabilization and decompression, followed by ventral spondylodesis. The patient achieved remarkable good functional recovery, demonstrating walking mobility and performing active wrist flexion and extension of the replanted extremity.<h4>Discussion</h4>Treatment of polytrauma patients is a challenging situation for healthcare providers. Acute life-threatening injuries must be addressed before peripheral injury patterns are treated. We describe rational and individual decision-making process to attempt macro-replantation of an upper extremity amputation in a polytrauma patient with additional dislocation fracture of the lumbar spine.<h4>Conclusion</h4>In this rare case, an excellent recovery after severe spinal cord injury and macro-replantation of traumatic amputation of the upper extremity is reported. Indication for macro-replantation of the upper extremity was an individual decision-making process conducted by an interdisciplinary team in consent with the patient's preferences and living conditions.