Muscat – Aster Royal Al Raffah Hospital, Muscat, has successfully managed and treated one of the most challenging orthopaedic trauma cases seen in recent times, involving a 65-year-old patient from Estonia who sustained multiple severe injuries during a tourist visit to Oman.

Andrus Lall, a consultant with Andren Konsult Construction Company from Rakvere, Estonia, had travelled to Oman for tourism when he suffered a major fall from a height of approximately six feet while visiting a wadi. The accident caused multiple critical injuries, including a D6 thoracic spine fracture and a rare, severely comminuted floating acetabular fracture extending into the iliac crest, an injury pattern rarely encountered in elderly patients.

The case became significantly more challenging because the patient was markedly obese and had multiple existing medical conditions including diabetes mellitus and hypertension, all of which substantially increased the risks associated with prolonged surgery, anesthesia, blood loss, wound healing, and postoperative recovery.

Initially treated at a government hospital, the patient was later referred to Aster Royal Al Raffah Hospital for definitive specialized trauma care. The timely transfer to a tertiary trauma center proved critical in enabling advanced surgical planning and multidisciplinary management.

Following extensive evaluation, the orthopaedic team led by Dr. Kalyan Srungavarapu and Dr. Sandesh Shetty, Consultants in Orthopaedic Surgery, formulated a highly specialized single-stage surgical plan. The complexity of the case was amplified not only by the fracture configuration and the patient’s obesity, but also by logistical and communication barriers, as the patient was alone in a foreign country with limited local family support and significant language difficulties during treatment and recovery.

The surgery, clinically categorized as a Complex Hip Reconstruction (CHR), involved multiple advanced procedures performed in a single sitting. The team first carried out open reduction and internal fixation (ORIF) of the acetabular fracture to stabilize the shattered pelvic anatomy. This was followed by structural bone graft reconstruction to restore bony integrity, and finally a complex total hip replacement to restore joint function and mobility.

The procedure lasted nearly six hours and required meticulous surgical precision, multidisciplinary coordination, prolonged anesthesia management, and transfusion of two units of blood. Due to the patient’s obesity and associated comorbidities, perioperative management was especially demanding.

The postoperative period also presented major medical challenges. During recovery, the patient began developing episodes of supraventricular tachycardia (SVT) and cardiac arrhythmias, causing sudden elevations in heart rate, particularly during periods of physical stress. These episodes required urgent cardiac monitoring and specialized intervention.

A dedicated cardiology team worked closely with the orthopaedic and critical care specialists to stabilize the patient’s cardiac status and carefully manage the arrhythmia before rehabilitation could safely proceed. Close collaboration between multiple specialties helped stabilize the patient and support recovery after surgery.

Speaking about the complexity of the case, Dr. Kalyan Srungavarapu, Consultant Orthopaedic Surgeon at Aster Royal Al Raffah Hospital, Muscat, said:

“This was an exceptionally difficult case because of the rare fracture pattern combined with obesity, diabetes, hypertension, and postoperative cardiac complications. Managing such severe injuries in an elderly obese patient always carries significant surgical and anesthetic risks. The positive outcome was achieved through coordinated decision-making, surgical expertise, and rapid clinical management.”

Dr. Sandesh Shetty, Consultant – Orthopaedic Surgeon, Aster Royal Al Raffah Hospital, Muscat, added:

“A single-stage surgery of this complexity requires meticulous preoperative planning, surgical precision and strong perioperative care.  I am glad that we were able to help Mr. Lall and we are pleased with the outcome and the patient’s recovery so far. The case demonstrates the growing sophistication of complex trauma care services within Oman.”.

Expressing his gratitude, Andrus Lall said:

“I am deeply thankful to the doctors and the entire medical team at Aster Royal Al Raffah Hospital. Being alone in a foreign country during such a difficult time was challenging, but the care and support I received made all the difference. The professionalism and compassion shown by everyone here have been truly remarkable, and thanks to their expertise, I was able to recover and return home safely.”