Open Lumbar Spine Fracture-Dislocation in a Rural Setting Associated With a Fall From Height: A Case Report

Open spinal fractures are rare and highly complex injuries associated with a high risk of infection and neurological impairment.We report a case of a previously healthy 25-year-old male who sustained a fall from approximately four meters in a rural setting, with direct impact of the lumbar region against a toilet, resulting in an extensive wound contaminated with feces, urine, soil, and ceramic fragments.Upon admission, he presented with an approximately 15-cm lacerated and contused wound, disruption of the paravertebral fascia, and exposure of the posterior spinal elements.Computed tomography revealed comminuted fractures of the posterior elements of L3, L4, and L5, with bone fragments displaced into the spinal canal and approximately 50% segmental stenosis, associated with injury to the posterior ligamentous complex.Neurological examination was normal, classified as Frankel grade E/American Spinal Injury Association (ASIA) grade E, with a Thoracolumbar Injury Classification and Severity Score (TLICS) of 7 points.Extensive surgical debridement, irrigation with more than 10 liters of saline solution, foreign-body removal, spinal canal decompression, repair of an approximately 2-cm dural tear, and posterior stabilization from L2 to S1 with pedicle screw instrumentation were performed.Due to the extensive soft-tissue injury, negative-pressure wound therapy was used.Wound cultures identified Proteus mirabilis, and targeted antibiotic therapy was administered for 28 days.The patient had no deep infection or neurological deficit and demonstrated satisfactory wound healing, bony fusion, and functional recovery at 180 days of followup.This case highlights the importance of early debridement, copious irrigation, contamination control, targeted antibiotic therapy, and surgical stabilization in open lumbar spinal fractures.