5yrs old boy presented to casualty apneic with GCS 9 and Bilateral equally reactive pupils after being struck by tractor trolly while playing.He was intubated and put on mechanical ventilation as per standardized protocol,seen by Neurosurgeon and advice surgery.INTERPRET CT BRAIN AND MANAGEMENT PLAN?

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Right parietal bone fracture with displaced fracture segment with minimal pneumocephalus with underlying hemorrhagic contusion with fracture of right shaft of femur with suspected fat embolism as a sequelae to fracture humerus. Initial treatment aims at managing apnoea if it is due to fat embolism. Then a neurosurgical intervention is needed for removal of displaced fracture segment or to replace it with bone cement and repair of dura - as increased chances of meningitis and or encephalitis. Give parenteral antibiotics preferably 3rd generation cephalosporins

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In the post - operative CT - the fractures bone segments have been removed but multiple pneumatoceles , diffuse cerebral oedema , and resolving underlying contusion is still there making recovery very slow

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Multiple # rt perietal with displaced # bone with sulcal blood in the rt parietal area.Brain is partially herniating out through the bony defects .Small pneumocephalus at the site of #. Tentorium mildly hyperdense in one cut ,the significance?. Ref to Neurosurgery

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Post Op CT Present status - Unconscious, Tracheostmised on Ventilator support,Pupils - B/l 4mm RTL,GCS -E1M4VT @Abhijit V sir,@Yashesh Dalal sir,@Manorama Rajan mam,@Bhupesh Kumar sir@Anand Kumar sir,@Parveen Yograj sir,@Padam Chand sir

Noted.. see ..This goes in accordance with my comment earlier..Surgery will not impact outcome.. i would not have done this surgery till I find that patient is now likely to survive...Till then only closed dressing and loose stitches to cover wond
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Case of RTA with head injury Ct scan - Rt. Parietal # with hemorrhagic contusion with( air cells )minimal pneumocephalus without mass Effect Rt mid shaft femur desplaced # Apneic due to fat embolism Look for urine for -fat globule Management- Airway maintaining Antiedema measure Neurosurgical opinion for fixation of # parietal bone and orthopedic opinion for Rt. Femur bone #correction with plating +?Rod insertion

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Hemorrhagic contusion on rt. Frontal lobe as shown in the CT followed by fracture of fronto temporal, with GCS score of 9 and intubated he does needs surgery... For femur bone fracture refer to orthopaedic.

Sir,it's artifact no Contusion in frontal lobe.thanks for opinion.
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Definitely this pt require surgery ,wound debridment ,removal of bony chips. And duroplasty , for femur fracture take orthopedic opinion , mean while do all blood work up , possibility of anaemia should be there rest supportive treatment

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Rt parietal hemorrhagic contusion and open fracture with pneumocephalus NSX opinion Broad spectrum antibiotics with coverage of both aerobic and anaerobic

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Surgery is reparative and not life saving or game changer.. can be done at a later stage, once it is confirmed that patient is surviving with ventilation and intensive care

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From orthopaedic point of view, the Thomas splint is enough till other serious injuries are managed Can improve the alignment of fracture by skin traction rope tied to distal part of splint.

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