traumatic hemipelvectomy -1.pdfVIP

Focus on Pelvic Trauma Traumatic Hemipelvectomy Ludwig Labler, Otmar Trentz, Marius Keel1 543European Journal of Trauma 2005 · No. 6 ? Urban Vogel European Journal of Trauma Ab stract Purpose: Open or closed traumatic hemipelvectomy is defined as a uni- or bilateral avulsion of the bony hemi- pelvis in combination with rupture of the large pelvic nerves and vessels and is usually accompanied by inju- ries of the genitourinary tract and bowel. According to a literature review between 1960 and 2005, 96 cases of traumatic hemipelvectomy were documented. Patients and Methods: Between 1998 and 2004, nine male patients fulfilled the criteria for a traumatic hemi- pelvectomy, out of 1.8% pelvic injuries (n = 507) and of 2.4% pelvic ring injuries (n = 373). Seven patients were admitted directly to the authors’ trauma center, one patient was admitted 3 h after the accident, and one patient was stabilized in another hospital and trans- ferred 5 days later. Results: All seven patients admitted primarily after trauma and the patient transferred 3 h later were in shock class IV. The traumatic hemipelvectomy was uni- lateral in eight patients with one complete avulsion and bilateral in one patient. Injuries of the pelvic ves- sels occurred in all patients. Most of the patients had injuries of both the genitourinary tract and the intes- tine. Associated injuries were mostly those of extremi- ties, thorax and head. Neurologic deficits could be doc- umented clinically on admission in four patients. Laparotomy for damage control with packing of the ab- dominal cavity and the retroperitoneum was per- formed in all cases. Four patients died during stabiliza- tion attempts in hemorrhagic shock during the first 4 h of treatment and three patients died after 3, 5, and 7 days in the intensive care unit because of septic compli- cations. Two patients survived with a follow-up of 21 and 34 months. Conclusion: Traumatic hemipelvectomy is a most se- vere pelvic ring injury