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Ping Jen J, Addison S, Amerasekera S. Rectal avulsion associated with complex open pelvic fracture following rollover injury. TRAUMA-ENGLAND 2022. [DOI: 10.1177/14604086211068618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background We present a rare case of complete rectal avulsion from the external anal sphincter complex associated with unstable pelvic ring disruption, including spinopelvic dissociation, following rollover by tractor. Purpose In the context of major pelvic trauma, evaluating for unstable bony, acute vascular, urethral and bladder injuries is essential. However, a detailed search for anorectal injury is also required by the reporting radiologist. Research Design: Case Study. Study Sample: 1. Data Collection and/or Analysis Retrospective analysis of computed tomography (CT). Results In this case report we highlight specific pelvic floor anatomy on CT, with a focus on gross morphology and the presence of peri-rectal free gas as primary evidence for injury. Secondary radiological evidence which should trigger the search for anorectal injury includes bony posterior pelvic ring disruption (sacrum or coccyx fractures) or associated Morel-Lavallée lesions. Conclusion The presence of radiological abnormality should prompt direct clinical inspection for corroboration. Early recognition is crucial for joint colorectal and orthopaedic management and the avoidance of delayed pelvic sepsis, which may become intractable.
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Affiliation(s)
- Jian Ping Jen
- Department of Radiology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Sarah Addison
- Department of General and Colorectal Surgery, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Steve Amerasekera
- Department of Radiology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Borger van der Burg BLS, van Dongen TTCF, Morrison JJ, Hedeman Joosten PPA, DuBose JJ, Hörer TM, Hoencamp R. A systematic review and meta-analysis of the use of resuscitative endovascular balloon occlusion of the aorta in the management of major exsanguination. Eur J Trauma Emerg Surg 2018; 44:535-550. [PMID: 29785654 PMCID: PMC6096615 DOI: 10.1007/s00068-018-0959-y] [Citation(s) in RCA: 99] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 04/18/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Circulatory collapse is a leading cause of mortality among traumatic major exsanguination and in ruptured aortic aneurysm patients. Approximately 40% of patients die before hemorrhage control is achieved. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an adjunct designed to sustain the circulation until definitive surgical or endovascular repair. A systematic review was conducted for the current clinical use of REBOA in patients with hemodynamic instability and to discuss its potential role in improving prehospital and in-hospital outcome. METHODS Systematic review and meta-analysis (1900-2017) using MEDLINE, Cochrane, EMBASE, Web of Science and Central and Emcare using the keywords "aortic balloon occlusion", "aortic balloon tamponade", "REBOA", and "Resuscitative Endovascular Balloon Occlusion" in combination with hemorrhage control, hemorrhage, resuscitation, shock, ruptured abdominal or thoracic aorta, endovascular repair, and open repair. Original published studies on human subjects were considered. RESULTS A total of 490 studies were identified; 89 met criteria for inclusion. Of the 1436 patients, overall reported mortality was 49.2% (613/1246) with significant differences (p < 0.001) between clinical indications. Hemodynamic shock was evident in 79.3%, values between clinical indications showed significant difference (p < 0.001). REBOA was favored as treatment in trauma patients in terms of mortality. Pooled analysis demonstrated an increase in mean systolic pressure by almost 50 mmHg following REBOA use. CONCLUSION REBOA has been used in trauma patients and ruptured aortic aneurysm patients with improvement of hemodynamic parameters and outcomes for several decades. Formal, prospective study is warranted to clarify the role of this adjunct in all hemodynamic unstable patients.
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Affiliation(s)
| | - Thijs T. C. F. van Dongen
- Department of Surgery, Alrijne Hospital, Simon Smitweg 1, 2353 GA Leiderdorp, The Netherlands
- Defense Healthcare Organization, Ministry of Defense, Utrecht, The Netherlands
| | - J. J. Morrison
- R. Adam Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, USA
| | | | - J. J. DuBose
- Division of Vascular Surgery, David Grant Medical Center, Travis AFB, California, USA
| | - T. M. Hörer
- Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro University, Örebro, Sweden
| | - R. Hoencamp
- Department of Surgery, Alrijne Hospital, Simon Smitweg 1, 2353 GA Leiderdorp, The Netherlands
- Defense Healthcare Organization, Ministry of Defense, Utrecht, The Netherlands
- Division of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
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Gamberini E, Coccolini F, Tamagnini B, Martino C, Albarello V, Benni M, Bisulli M, Fabbri N, Hörer TM, Ansaloni L, Coniglio C, Barozzi M, Agnoletti V. Resuscitative Endovascular Balloon Occlusion of the Aorta in trauma: a systematic review of the literature. World J Emerg Surg 2017; 12:42. [PMID: 28855960 PMCID: PMC5575940 DOI: 10.1186/s13017-017-0153-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 08/14/2017] [Indexed: 12/26/2022] Open
Abstract
AIMS Resuscitative endovascular balloon occlusion of the aorta has been a hot topic in trauma resuscitation during these last years. The aims of this systematic review are to analyze when, how, and where this technique is performed and to evaluate preliminary results. METHODS The literature search was performed on online databases in December 2016, without time limits. Studies citing endovascular balloon occlusion of the aorta in trauma were retrieved for evaluation. RESULTS Sixty-one articles met the inclusion criteria and were selected for the systematic review. Overall, they included 1355 treated with aortic endovascular balloon occlusion, and 883 (65%) patients died after the procedure. In most of the included cases, a shock state seemed to be present before the procedure. Time of death and inflation site was not described in the majority of included studies. Procedure-related and shock-related complications are described. Introducer sheath size and comorbidity seems to play the role of risk factors. CONCLUSIONS Resuscitative endovascular balloon occlusion of the aorta is increasingly used in trauma victim resuscitation all over the world, to elevate blood pressure and limit fluid infusion, while other procedures aimed to stop the bleeding are performed. High mortality rate is probably due to the severity of the injuries. Time and place of balloon insertion, zone of balloon inflation, and inflation cutoff time are very heterogeneous.
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Affiliation(s)
- Emiliano Gamberini
- Anesthesia and Intensive Care Department, AUSL Romagna Trauma Center "Maurizio Bufalini" Hospital, Viale Ghirotti 286, 47521 Cesena, Italy
| | - Federico Coccolini
- General and Emergency Surgery Department, ASST Trauma Center "Papa Giovanni XXIII" Hospital, Piazza OMS 1, 24127 Bergamo, Italy
| | - Beatrice Tamagnini
- Emergency Medicine, University of Modena and Reggio Emilia, via Università 4, 41121 Modena, Italy
| | - Costanza Martino
- Anesthesia and Intensive Care Department, AUSL Romagna Trauma Center "Maurizio Bufalini" Hospital, Viale Ghirotti 286, 47521 Cesena, Italy
| | - Vittorio Albarello
- Anesthesia and Intensive Care Department, AUSL Romagna Trauma Center "Maurizio Bufalini" Hospital, Viale Ghirotti 286, 47521 Cesena, Italy
| | - Marco Benni
- Anesthesia and Intensive Care Department, AUSL Romagna Trauma Center "Maurizio Bufalini" Hospital, Viale Ghirotti 286, 47521 Cesena, Italy
| | - Marcello Bisulli
- Interventional Radiology Department, AUSL Romagna Trauma Center "Maurizio Bufalini" Hospital, Viale Ghirotti 286, 47521 Cesena, Italy
| | - Nicola Fabbri
- General and Emergency Surgery Department, AUSL Romagna Trauma Center "Maurizio Bufalini" Hospital, Viale Ghirotti 286, 47521 Cesena, Italy
| | - Tal Martin Hörer
- Cardiothoracic and Vascular Surgery Department, Örebro University Hospital, Södra Grev Rosengatan, 701 85 Örebro, Sweden
| | - Luca Ansaloni
- General and Emergency Surgery Department, ASST Trauma Center "Papa Giovanni XXIII" Hospital, Piazza OMS 1, 24127 Bergamo, Italy
| | - Carlo Coniglio
- Anesthesia, Intensive Care and 118 Emergency System Department, AUSL Bologna Trauma Center "Maggiore" Hospital, Largo Nigrisoli 2, 40133 Bologna, Italy
| | - Marco Barozzi
- Emergency Medicine Department, AUSL Modena Trauma Center "Sant'Agostino" Hospital, Via Pietro Giardini 1355, 41126 Modena, Italy
| | - Vanni Agnoletti
- Anesthesia and Intensive Care Department, AUSL Romagna Trauma Center "Maurizio Bufalini" Hospital, Viale Ghirotti 286, 47521 Cesena, Italy
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Song W, Zhou D, Xu W, Zhang G, Wang C, Qiu D, Dong J. Factors of Pelvic Infection and Death in Patients with Open Pelvic Fractures and Rectal Injuries. Surg Infect (Larchmt) 2017; 18:711-715. [PMID: 28759327 DOI: 10.1089/sur.2017.083] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Open pelvic fractures associated with rectal injuries are uncommon. They often cause serious pelvic infection, even death. This combination of injuries has been reviewed infrequently. Herein, we report factors associated with pelvic infection and death in a group of patients with open pelvic fractures and concurrent rectal injuries. METHODS We retrospectively reviewed the records of patients with open pelvic fractures and rectal injuries who were treated at our institution from January 2010-April 2014. From the medical records, age, gender, Injury Severity Score (ISS), cause of fracture, associated injuries, classification of the fracture, degree of soft-tissue injury, Glasgow Coma Score (GCS), Revised Trauma Score (RTS), packed red blood cells (PRBCs) needed, presence/absence of shock, early colostomy (yes or no), drainage (yes or no), and rectal washout (yes or no) were extracted. Univariable and multivariable analysis were performed to determine the association between risk factors and pelvic infection or death. RESULTS Twenty patients were identified. Pelvic infection occurred in 50% (n = 10) of the patients. Four patients suffered septicemia, and three patients died of multiple organ dysfunction. The mortality rate thus was 15%. According to the univariable analysis, the patients in whom pelvic infection developed had shock, RTS ≤8, GCS ≤8, blood transfusion ≥10 units in the first 24 h, no colostomy, or Gustilo grade III soft-tissue injury. According to the multivariable analysis, shock and absence of colostomy were independently associated with pelvic infection. By univariable analysis, the only factor associated with death was RTS ≤8. CONCLUSION The incidence of pelvic infection was lower in patients having early colostomy (p < 0.05). Patients with shock had a higher risk of pelvic infection, and we recommend aggressive measures to treat these patients. According to our results, RTS ≤8 could be a predictor of poor outcomes in patients with open pelvic fracture and concurrent rectal injury. Open reduction and internal fixation after extensive debridement is recommended in patients with unstable pelvic fractures.
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Affiliation(s)
- Wenhao Song
- Department of Orthopedic Surgery, Shandong Provincial Hospital affiliated to Shandong University , Shandong, People's Republic of China
| | - Dongsheng Zhou
- Department of Orthopedic Surgery, Shandong Provincial Hospital affiliated to Shandong University , Shandong, People's Republic of China
| | - Weicheng Xu
- Department of Orthopedic Surgery, Shandong Provincial Hospital affiliated to Shandong University , Shandong, People's Republic of China
| | - Guoming Zhang
- Department of Orthopedic Surgery, Shandong Provincial Hospital affiliated to Shandong University , Shandong, People's Republic of China
| | - Chunhui Wang
- Department of Orthopedic Surgery, Shandong Provincial Hospital affiliated to Shandong University , Shandong, People's Republic of China
| | - Daodi Qiu
- Department of Orthopedic Surgery, Shandong Provincial Hospital affiliated to Shandong University , Shandong, People's Republic of China
| | - Jinlei Dong
- Department of Orthopedic Surgery, Shandong Provincial Hospital affiliated to Shandong University , Shandong, People's Republic of China
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Yun SJ, Jin W, Yoon SH, Chun YS, Cha JG, Koo HS, Park SY, Park JS, Ryu KN, Lee SH, Shin JS. Diagnostic performance of abdominal CT for diagnosis of pelvic fractures: comparison with pelvic CT. Acta Radiol 2016; 57:1244-50. [PMID: 26787672 DOI: 10.1177/0284185115626473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 11/23/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND In the emergency department, patients with abdominopelvic trauma inadvertently undergo both abdominal computed tomography (CT) (for intra-abdominal and intra-pelvic organs) and pelvic CT (CT with multiplanar reformation in three orthogonal planes of the bony pelvis). However, the systemic use of CT is concerning given the cumulative radiation dose. PURPOSE To evaluate the diagnostic value of abdominal CT in comparison to pelvic CT in patients with suspected pelvic fractures. MATERIAL AND METHODS Seventy-two patients who underwent abdominal CT and pelvic CT within a 2-week period to evaluate pelvic fractures were included. Two reviewers retrospectively analyzed eight anatomical regions of the pelvic bones on both abdominal CT and pelvic CT over a 1-week interval. The interpretation of pelvic CT scans by two senior musculoskeletal radiologists was considered as the reference standard. Diagnostic performance and inter-observer agreement of both CT scans were evaluated. RESULTS For reviewers 1 and 2, abdominal CT showed high accuracy (98% and 98%, respectively) as did pelvic CT. For both abdominal CT and pelvic CT, fracture detection in all anatomical regions of the pelvic bones was not significantly different for the two reviewers (P ≥ 0.25). Inter-observer agreement for all anatomical regions of the pelvic bones was excellent or good (k = 0.785-1.0). CONCLUSION Not only pelvic CT but also abdominal CT is acceptable for detection of pelvic fractures, in spite of its thicker sections and different reconstruction algorithm. Therefore, if abdominal CT has already been performed, additional pelvic CT might no longer be necessary in order to exclude a pelvic fracture.
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Affiliation(s)
- Seong Jong Yun
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Wook Jin
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - So Hee Yoon
- Department of Radiology, National Police Hospital, Seoul, Republic of Korea
| | - Young Soo Chun
- Department of Orthopedic Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Jang Gyu Cha
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Hye-Soo Koo
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - So Young Park
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Ji Seon Park
- Department of Radiology, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Kyung Nam Ryu
- Department of Radiology, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Sun Hwa Lee
- Department of Emergency Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea
| | - Jong Soo Shin
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Republic of Korea
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Wang H, Robinson RD, Moore B, Kirk AJ, Phillips JL, Umejiego J, Chukwuma J, Miller T, Hassani D, Zenarosa NR. Predictors of early versus late mortality in pelvic trauma patients. Scand J Trauma Resusc Emerg Med 2016; 24:27. [PMID: 26964737 PMCID: PMC4785731 DOI: 10.1186/s13049-016-0220-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 03/04/2016] [Indexed: 11/22/2022] Open
Abstract
Background Risks of predicting time-related in-hospital mortality varies in pelvic trauma patients. We aim to identify potential independent risks predictive of time-related (early versus late) mortality among pelvic trauma patients. Methods Local trauma registry data from 2004 through 2013 were reviewed. Mortality causes and timing of death were investigated. Multivariate logistic regression identified independent risks predictive of early versus late mortality in pelvic trauma patients while adjusting for patient demographics (age, sex, race), clinical variables (initial vital signs, mental status, injury severity, associated injuries, comorbidities), and hospital outcomes (surgical interventions, crystalloid resuscitations, blood transfusions). Results We retrospectively collected data on 1566 pelvic trauma patients with a mortality rate of 9.96 % (156/1566). Approximately 74 % of patients died from massive hemorrhage within the first 24 h of hospitalization (early mortality). Revised trauma score (RTS), injury severity score (ISS), initial hemoglobin, direct transfer to operating room, and blood transfusion administration in the Emergency Department were considered independent risk factors predictive of early mortality. Age, ISS, and Glasgow Coma Scale (GCS) were deemed risk factors predictive of death after 24 h (late mortality). Discussion Given the fact of a substantial number of patients died within the first 24 h of hospital arrival, it is reasonable to consider the first 24 h of hospitalization as the appropriate window within which early mortality may be expected to occur in pelvic trauma patients. The risk factors associated with massive hemorrhage were strong predictors of early mortality, whereas late mortality predictors were more closely linked with comorbidities or in-hospital complications. Conclusions While risk factors predictive of early versus late mortality vary, ISS seems to predict both early and late mortality accurately in pelvic trauma patients.
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Affiliation(s)
- Hao Wang
- Emergency Department, JPS Health Network, 1575 S. Main St, Fort Worth, TX, 76104, USA.
| | - Richard D Robinson
- Emergency Department, JPS Health Network, 1575 S. Main St, Fort Worth, TX, 76104, USA
| | - Billy Moore
- Research Institute, JPS Health Network, 1500 S. Main St, Fort Worth, TX, 76104, USA
| | - Alexander J Kirk
- Emergency Department, JPS Health Network, 1575 S. Main St, Fort Worth, TX, 76104, USA
| | | | - Johnbosco Umejiego
- Emergency Department, JPS Health Network, 1575 S. Main St, Fort Worth, TX, 76104, USA
| | - Joseph Chukwuma
- Emergency Department, JPS Health Network, 1575 S. Main St, Fort Worth, TX, 76104, USA
| | - Tyler Miller
- Emergency Department, JPS Health Network, 1575 S. Main St, Fort Worth, TX, 76104, USA
| | - Donna Hassani
- University of South Florida, Morsani College of Medicine, 12901 Bruce B. Downs Blvd., MDC061, Tampa, FL, 33612-4799, USA
| | - Nestor R Zenarosa
- Research Institute, JPS Health Network, 1500 S. Main St, Fort Worth, TX, 76104, USA
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Shimizu T, Matsuda S, Sakuragi A, Tsukie T, Kawanabe K. Simultaneous occurrence of a severe Morel-Lavallée lesion and gluteal muscle necrosis as a sequela of transcatheter angiographic embolization following pelvic fracture: a case report. J Med Case Rep 2015; 9:69. [PMID: 25890103 PMCID: PMC4381358 DOI: 10.1186/s13256-015-0550-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Accepted: 02/19/2015] [Indexed: 12/02/2022] Open
Abstract
Introduction Morel-Lavallée lesions are posttraumatic hemolymphatic collections caused by disruption of the interfascial planes between the subcutaneous soft tissue and muscle. Severe peripelvic Morel-Lavallée lesions have rarely been reported in the literature. By contrast, a number of cases of gluteal muscle necrosis following transcatheter angiographic embolization for pelvic fracture have been reported. Each entity can result in severe infection and sepsis, and the mortality rate in such cases is quite high. However, to date, no previous reports have described a case in which these life-threatening entities occurred simultaneously. Case presentation A 32-year-old Asian man simultaneously developed severe peripelvic Morel-Lavallée lesions and gluteal muscle necrosis with sepsis following transcatheter angiographic embolization after an unstable pelvic fracture. Extremely large skin and soft tissue defects, which were untreatable with any commonly used flaps, were generated after repeated debridement. In addition, a deep-bone infection was suspected in his left fractured iliac bone, while motor function was almost completely lost in his left leg, possibly as a sequela of transcatheter angiographic embolization. As a result of his condition, a left hemipelvectomy was unavoidable. A pedicled fillet flap from his sacrificed left limb was used for the treatment of the defects and to provide a durable base for a prosthesis. Our patient survived and returned to his previous job 24 months after the surgery wearing a prosthetic left leg. Conclusion As illustrated by the present case, severe peripelvic Morel-Lavallée lesions and gluteal muscle necrosis following transcatheter angiographic embolization can occur simultaneously after unstable pelvic fractures. Physicians should recognize that these entities can result in life-threatening sepsis and, therefore, should attempt to detect them as early as possible. When hemipelvectomy is unavoidable, a pedicled upper and lower leg in-continuity fillet flap may provide satisfactory outcomes.
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Affiliation(s)
- Takayoshi Shimizu
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawaharacho, Syogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Shuichi Matsuda
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawaharacho, Syogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Atsushi Sakuragi
- Department of Orthopedic Surgery, Nagahama City Hospital, 313 Ouinuicho, Nagahama, Shiga, 526-0043, Japan.
| | - Tomio Tsukie
- Department of Plastic Surgery, Kitano Hospital, 2-4-20 Ougimachi, Kita-ku, Osaka city, Osaka, 530-8480, Japan.
| | - Keiichi Kawanabe
- Department of Orthopedic Surgery, Shiga Medical Center for Adults, 5-4-30 Moriyama, Moriyama city, Shiga, 524-8524, Japan.
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Mardanpour K, Rahbar M. The outcome of surgically treated traumatic unstable pelvic fractures by open reduction and internal fixation. J Inj Violence Res 2012; 5:77-83. [PMID: 23103962 PMCID: PMC3683417 DOI: 10.5249/jivr.v5i2.138] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Accepted: 04/16/2012] [Indexed: 10/30/2022] Open
Abstract
BACKGROUND This study was performed to evaluate functional and radiological results of pelvic ring fractures treatment by open reduction and internal fixation. METHODS Thirty eight patients with unstable pelvic fractures, treated from 2002 to 2008 were retrospectively reviewed. The mean patients' age was 37 years (range 20 to 67). Twenty six patients were men (4 patients with type B and 22 patients with type C fracture) and 12 women (7 patients with type B and 5 patients with type C fracture). The commonest cause was a road traffic accident (N=37, about 97%). Internal fixation was done by plaque with ilioinguinal and Kocher-Langenbeek approaches for anterior, posterior pelvic wall and acetabulum fracture respectively. Quality of reduction was graded according to Majeed score system. RESULTS There were 11 type-C and 27 type-B pelvic fractures according to Tile's classification. Thirty six patients sustained additional injuries. The commonest additional injury was lower extremity fracture. The mean follow-up was 45.6 months (range 16 to 84 months).The functional outcome was excellent in 66%, good in 15%, fair in 11% and poor in 7% of the patients with type B pelvic fractures and functional outcome was excellent in 46%, good in 27%, fair in 27% and poor in 0% of the patients with type C pelvic fractures. There were four postoperative infections. No sexual functional problem was reported. Neurologic problem like Lateral cutaneous nerve of thigh injury recovered completely in 2 patients and partially in 2 patients. There was no significant relation between functional outcome and the site of fracture (P greater than 0.005). CONCLUSIONS Unstable pelvic ring fracture injuries should be managed surgically by rigid stabilization. It must be carried out as soon as the general condition of the patient permits, and even up to two weeks.
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Abstract
High energy fractures of the pelvis are a challenging problem both in the immediate post-injury phase and later when definitive fixation is undertaken. No single management algorithm can be applied because of associated injuries and the wide variety of trauma systems that have evolved around the world. Initial management is aimed at saving life and this is most likely to be achieved with an approach that seeks to identify and treat life-threatening injuries in order of priority. Early mortality after a pelvic fracture is most commonly due to major haemorrhage or catastrophic brain injury. In this article we review the role of pelvic binders, angiographic embolisation, pelvic packing, early internal fixation and blood transfusion with regard to controlling haemorrhage. Definitive fixation seeks to prevent deformity and reduce complications. We believe this should be undertaken by specialist surgeons in a hospital resourced, equipped and staffed to manage the whole spectrum of major trauma. We describe the most common modes of internal fixation by injury type and review the factors that influence delayed mortality, adverse functional outcome, sexual dysfunction and venous thromboembolism.
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Affiliation(s)
- H. C. Guthrie
- Trauma and Orthopaedic Department, St George’s Hospital, Blackshaw Road, Tooting, London SW17 0QT, UK
| | - R. W. Owens
- Trauma and Orthopaedic Department, St George’s Hospital, Blackshaw Road, Tooting, London SW17 0QT, UK
| | - M. D. Bircher
- Trauma and Orthopaedic Department, St George’s Hospital, Blackshaw Road, Tooting, London SW17 0QT, UK
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