# Successful macro-replantation of traumatic upper extremity amputation and type C-spinal cord injury with good functional recovery – a case report

## TL;DR

A patient with a traumatic arm amputation and spinal injury made a surprising recovery after receiving timely and coordinated medical interventions.

## Contribution

Reports a rare case of successful macro-replantation and spinal recovery in a polytrauma patient with excellent functional outcomes.

## Key findings

- The patient achieved walking mobility and active wrist movement after replantation and spinal surgery.
- A neurological improvement from ASIA A to ASIA D following a Type C spinal fracture was observed.
- Timely and individualized decision-making contributed to the successful outcome in this complex case.

## Abstract

Traumatic amputation and unstable spine injury both require timely interventions to achieve best outcome. A young polytrauma patient with upper extremity amputation and spinal cord injury is presented. The patient underwent macro-replantation of the upper extremity and spinal canal decompression and dorsal stabilization.

A male patient sustained polytrauma from a train accident with traumatic amputation of the right forearm. Diagnostic work-up revealed severe thoracic injuries and an open translocation injury type C L1/L2. The morphology was suggestive of complete paraplegia resulting in wheelchair-dependency.

After initial treatment according to ATLS™ guidelines, replantation of the upper extremity was achieved within 5 h. A 30-degree elbow arthrodesis was established for future wheelchair mobility. Spinal cord injuries were addressed using dorsal spinal stabilization and decompression, followed by ventral spondylodesis.

The patient achieved remarkable good functional recovery, demonstrating walking mobility and performing active wrist flexion and extension of the replanted extremity.

Treatment of polytrauma patients is a challenging situation for healthcare providers.

Acute life-threatening injuries must be addressed before peripheral injury patterns are treated. We describe rational and individual decision-making process to attempt macro-replantation of an upper extremity amputation in a polytrauma patient with additional dislocation fracture of the lumbar spine.

In this rare case, an excellent recovery after severe spinal cord injury and macro-replantation of traumatic amputation of the upper extremity is reported. Indication for macro-replantation of the upper extremity was an individual decision-making process conducted by an interdisciplinary team in consent with the patient's preferences and living conditions.

•Unique case: Unexpected excellent recovery after severe spinal cord injury and traumatic amputation of the upper extremity.•Both upper limb amputation and spinal cord injury require timely intervention.•The decision-making process regarding the potential for replantation must consider the overall context of the patient.•A neurological transition from ASIA A to ASIA D following a Type C fracture is extremely rare.

Unique case: Unexpected excellent recovery after severe spinal cord injury and traumatic amputation of the upper extremity.

Both upper limb amputation and spinal cord injury require timely intervention.

The decision-making process regarding the potential for replantation must consider the overall context of the patient.

A neurological transition from ASIA A to ASIA D following a Type C fracture is extremely rare.