Fig. 4.

A 18-year-old male diagnosed with grade 2 splenic laceration, intraperitoneal bladder rupture with diaphragmatic hernia left side (a) with left superior and inferior pubic rami fracture and closed diaphyseal fractures of the left femur (b) and tibia (c). On arrival, patient showed bradycardia, blood pressure of 114/60 mm Hg, GCS was E4, V5, and M6 (15/15) with absent breath sounds on the left side chest. Serum lactate was 7.2 mmol/L. After resuscitation, bladder and diaphragmatic hernia repair along with ICD insertion (f), splenectomy and external fixator application for the left femur (d) and tibia (e) fractures on day 1 were performed. Definitive fixation of the left femur (g) and tibia fractures (h) was performed later.