Authors: Malak Mohammed Alshabi

Abstract

Background: Complex injuries involving several organ systems can be caused by high-energy occupational trauma. Patients who first seem neurologically intact may have traumatic brain injury (TBI), especially if there are more obvious orthopedic impairments. Finding modest neurological abnormalities that might affect treatment choices still requires careful clinical screening.

Case Presentation: 64-year-old hypertensive male came to our emergency department (ED) as a result of being struck by a vehicle at work. Witnesses said he briefly lost consciousness at the scene and could not remember what occurred afterward. On admission, his GCS was 15, and he was conscious. Anisocoria was noted on neurological examination. Computed tomography of the brain demonstrated a small right frontal cerebral contusion with mild surrounding edema and an associated subgaleal hematoma, without skull fracture or midline shift. A complicated injury was shown by radiological scans of the right lower leg: a comminuted fracture of the upper third of the fibula with slight displacement and soft tissue edema, a spiral fracture of the distal tibia extending into the ankle, and fractures of the medial malleolus and fibula. The patient had open reduction and internal fixation of the distal tibial and medial malleolar fractures with an ankle arthrotomy following a multidisciplinary evaluation and confirmation of physiological stability. The patient had a straightforward surgical course and was observed for neurological and hemodynamic issues in the critical care unit.

Conclusion: High-energy occupational pedestrian trauma may lead to clinically influential neurological and orthopedic injuries, despite an obviously comforting appearance. The case's sustained awareness and normal GCS score did not rule out TBI since anisocoria prompted additional tests and showed a frontal cerebral contusion

Keywords: Occupational trauma, polytrauma, traumatic brain injury, anisocoria, lower-extremity fractures, orthopedic fixation.