Challenging management of multifocal upper extremity fractures in a polytrauma setting: A case report

Introduction and importance: Multifocal fractures in a single upper extremity represent a significant clinical challenge, often resulting from high-energy impacts such as motor vehicle accidents or severe falls. These injuries require complex, multifaceted approaches in management, spanning initial acute care to long-term rehabilitation. This paper examines the complexities of diagnosing, treating, and rehabilitating multifocal upper extremity fractures, highlighting the importance of timely intervention and a multidisciplinary approach to maximize functional recovery, minimize long-term disability and the prognosis. Case presentation: A 25-year-old male was admitted to the emergency department after being struck by a vehicle, sustaining multiple fractures in his right upper extremity, including the scapula, proximal humerus, radius, and ulna. Initial management involved stabilizing the fractures with external fixation and performing a craniotomy for an associated epidural hematoma. After stabilization, definitive surgical repairs were performed, including ORIF for the humerus and radius ulna, followed by rehabilitation to address functional deficits. Clinical discussion: The management of multiple fractures in a single upper extremity requires timely surgical interventions, such as ORIF, to stabilize complex fracture patterns. Effective postoperative rehabilitation is essential for recovery and depends heavily on patient compliance and comprehensive care. Although advances in surgical techniques have improved outcomes, challenges remain in reducing soft tissue damage and preventing long-term complications like joint stiffness and chronic pain. Conclusion: Multiple fractures in a single upper extremity usually result from high-energy trauma, necessitating comprehensive management strategies.