Medical Challenge Case
Case: Bicycle Trouble
S: 19-year-old man is brought into the hospital after being impaled on his bicycle. The patient was riding his bicycle at a nearby park at about 25MPH when he was side swiped by another cyclist. He had been thrown 20 feet in the air and had landed on his mountain bike with an impact so hard that it drove the end of the left handle bar and brake deep into his thigh. The paramedics did not remove the metal and delivered the cyclist to the emergency room with the handlebars still in his thigh. He had been wearing a helmet, and didn’t think he had hit his head. Four men apparently maneuvered the stretcher, while another 3 supported the remnant of a crumpled bicycle frame that was jutting from his left leg. As much of the bike as possible was removed or cut away to facilitate, transport and reduce further damage to the leg.
O: Patient was obviously in severe pain. He was conscious and talking. Patient had sensation in the lower part of the leg suggesting that no major nerves had been severed. Pulses behind the knee were also felt indicating major blood vessels of the thigh were possibly intact. Physical examination revealed head, lungs, belly, kidneys were all fine. No sign of concussion, fracture, or even bad bruises anywhere else. The handle had moved through the flesh with such force that it neatly compressed large blood vessels en route and the heat of the friction had apparently sealed off, literally, cauterizing the small bleeders as well. Pulse was present in the lower leg and patient was able to wiggle toes following the administration of morphine. X-ray showed the handle bar had lodged in the front of the thigh with the break lever gently cradling the femur. No sign of fracture. A small amount of dye was injected into the patient to monitor circulation, which revealed that there was no leakage.
A: What is your diagnosis of this patient?
P: What is your recommended plan of treatment?