Multiple Extremity Injuries After Motorcycle Accident

A 35-year-old male is involved in a motor vehicle accident and is brought in by paramedics complaining of severe pain in both legs and in his right arm. In the ED, the patient is awake and alert. He has an obvious deformity of his right mid-humerus. There are no open wounds in the arm. He has a noticeable wrist-drop on the right and is unable to dorsiflex the wrist or extend the metacarpophalangeal joints. Radial pulse on the right is 2+. On exam of his right leg, there is an obvious deformity of the right thigh as well as in the mid-tibia. There is a 2 cm laceration over his mid-shin, with visible bone exposed. Distal motor and sensory function in his right leg are intact, and pedal pulses are 2+. On the left he has a swollen knee with an obvious effusion. There is no tenderness or deformity in his left thigh or left lower leg. X-ray imaging confirms a right mid-shaft humerus fracture (shown below), a right femur fracture, and a right tibia and fibula fracture. X-rays of the left knee are negative.