857 The Lightning Le Fort: Contemporary Management of Lightning Strike Injuries Including Craniofacial Fractures

TL;DR

This case report describes the treatment of a 70-year-old man with craniofacial fractures and burns after a lightning strike, highlighting the importance of a multidisciplinary approach.

Contribution

The paper presents a rare case of lightning strike injuries with Le Fort II and III-like fractures, emphasizing non-operative craniofacial management and biosynthetic skin substitute use.

Findings

Non-operative management was successful for minimally displaced Le Fort II and III-like fractures with intact pterygoid plates.

A biosynthetic skin substitute effectively treated a 6% TBSA second-degree burn without autografting.

Multidisciplinary consultation improved outcomes in managing complex lightning strike injuries.

Abstract

Lightning strikes are a rare cause of multisystem trauma, often leading to complex injuries. Given the rarity of this mechanism, case reports may be instructional. Optimal care requires a multidisciplinary approach in managing such complex trauma.

A 70-year-old male presented with concurrent traumatic and burn injuries following a lightning strike. Upon presentation, the patient underwent immediate stabilization according to Advanced Trauma Life Support (ATLS) and Advanced Burn Life Support (ABLS) protocols, including primary and secondary surveys. A comprehensive trauma assessment was conducted, utilizing imaging studies to determine the full extent of craniofacial and associated injuries. Imaging revealed bilateral Le Fort II and III-like fractures with intact pterygoid plates, which directed the decision towards non-operative management of the craniofacial injuries. Wound assessment revealed 6% TBSA second-degree burns on the left upper extremity which were surgically managed with debridement and the application of a biosynthetic skin substitute.

The patient was diagnosed with bilateral non-hemorrhagic inferior frontal lobe contusions, Le Fort II and III-like fractures, and a second-degree burn on the left upper extremity (TBSA 6%). The patient received consultations from multiple specialties, including neurosurgery, otolaryngology, ophthalmology, and plastic surgery, to develop a tailored treatment plan. The craniofacial fractures were managed non-operatively, while the burn wound was treated surgically without the need for autografting.

This case underscores the importance of a multidisciplinary approach in managing lightning strike injuries, particularly when craniofacial fractures are involved. The unique vector of force in this patient spared the pterygoid plates, resulting in minimally displaced Le Fort-like fractures, which were managed conservatively. The use of a biosynthetic skin substitute facilitated optimal burn healing without the need for donor site creation, demonstrating its efficacy in managing partial-thickness burns.

Co-location of specialized trauma and burn services along with subspecialty consultation allows for optimal, timely care of complex injuries which may occur secondary to lightning strike.

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