Management of traumatic hemipelvectomy: an institutional experience on four consecutive cases

Tian-Hao Wu,A-Qin Peng,Chun-Sheng Wu,Ying-Ze Zhang,Xiao Zhang,Xi-Rui Wu

doi:10.1186/1757-7241-21-64

Abstract

Background and objectiveThe incidence of traumatic hemipelvectomy is rare, but it is a devastating injury. Recently, an increasing number of patients with traumatic hemipelvectomy are admitted to trauma centers alive due to improvements of the pre-hospital care. Successful management requires prompt recognition of the nature of this injury and meticulous surgical technique. We present our successful experiences on four cases of traumatic hemipelvectomy in the past nine years.Patients and methodsFour cases with traumatic hemipelvectomy were admited to our hospital from June 21, 2002 to September 3, 2011. All injuries occurred due to vehicle accident and all patients were in a state of severe hypotension, with two of them having anal lacerations. These four cases were treated immediately with resuscitation, control of hemorrhage, early amputation, repeated debridement and closure of the wounds. An angiographic embolization was given to control hemorrhage in two of the cases preoperatively. One case underwent fecal diversion. Wound infection occurred in all of cases which was successfully controlled by repeated debridements, effective anti-biotic regimen, split-thickness skin grafts.ResultsAll four cases were saved successfully with well-healed wounds during follow up from 1 to 7 years. They were able to walk by themself using crutches.ConclusionAdhering to the surgery principles of damage control including appropriate resuscitation, hemorrhage control, coagulopathy correction and multiple debridements and closure of the wounds in reasonable period of time can save the life of cases suffering from severe pelvic ring injury.

Highlights

Adhering to the surgery principles of damage control including appropriate resuscitation, hemorrhage control, coagulopathy correction and multiple debridements and closure of the wounds in reasonable period of time can save the life of cases suffering from severe pelvic ring injury
Case 3 A 41-year-old female, who was crushed from behind by a car while cycling, was admitted to our hospital with a bleeding wound in the medial of the right hip and the right lower limb unable to move for 12 h. Because her blood pressure was undetectable on admission to the local hospital, she received a transfusion of 6 units of red blood cells (RBCs)
Traumatic hemipelvectomy is a special type of pelvic fracture that is characterized by the wide separation of the innominate bone from the pubic symphysis and sacrum, the avulsion of the external iliac vessels, and the severe stretch injury or disruption of the femoral and sciatic nerves

Summary

Patients and methods

Four cases with traumatic hemipelvectomy were admited to our hospital from June 21, 2002 to September 3, 2011. All injuries occurred due to vehicle accident and all patients were in a state of severe hypotension, with two of them having anal lacerations. These four cases were treated immediately with resuscitation, control of hemorrhage, early amputation, repeated debridement and closure of the wounds. An angiographic embolization was given to control hemorrhage in two of the cases preoperatively. Wound infection occurred in all of cases which was successfully controlled by repeated debridements, effective anti-biotic regimen, split-thickness skin grafts

Conclusion

Introduction

Discussion