Avoiding Complications in Acetabular and Pelvic Fractures
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Rare Combination of Ipsilateral Acetabular Fracture-Dislocation and Pertrochanteric Fracture
A Case Report & Literature Review Rare Combination of Ipsilateral Acetabular Fracture-Dislocation and Pertrochanteric Fracture Kevin M. Kuhn, CDR, MC, USN, John A. Boudreau, MD, and J. Tracy Watson, MD oral fractures. Other case reports have described acetabular Abstract fracture-dislocations associated with femoral neck fractures.1-3 Acetabular fracture-dislocations are severe This case report describes an acetabular fracture-dislocation injuries that require urgent closed reduction associated with an ipsilateral pertrochanteric fracture and sub- of the hip and often require surgery to restore trochanteric extension. hip stability. Other authors have described We propose a staged treatment strategy consisting of early acetabular fracture-dislocations associated minimally invasive reduction of the hip and delayed reduction with femoral neck fractures, but to our knowl- and fixation of the fractures. This strategy may be useful in edge, this case report is the first to describe an managing a polytraumatized patient who may not be stable acetabular fracture-dislocation in association enough to undergo early definitive management, or a patient with an ipsilateral pertrochanteric fracture and who requires prolonged transfer to receive definitive care. subtrochanteric extension. The patient provided written informed consent for print The polytraumatized patient initially was not and electronic publication of this case report. stable enough for prolonged surgery. Through a 3-cm anterolateral hip incision, a 5-mmAJO Schanz Case Report screw was introduced percutaneously into the A 44-year-old man was involved in a head-on motor vehicle femoral head through the primary fracture site collision at highway speed. He was taken to a local hospital, under fluoroscopic guidance. -
Methods and Guidelines for Venous Thromboembolism Prevention in Polytrauma Patients with Pelvic and Acetabular Fractures
Send Orders for Reprints to [email protected] The Open Orthopaedics Journal, 2015, 9, (Suppl 1: M6) 313-320 313 Open Access Methods and Guidelines for Venous Thromboembolism Prevention in Polytrauma Patients with Pelvic and Acetabular Fractures Francisco Chana-Rodríguez*, Rubén Pérez Mañanes, José Rojo-Manaute, José Antonio Calvo Haro and Javier Vaquero-Martín Department of Traumatology and Orthopaedic Surgery, General University Hospital Gregorio Marañón, Madrid, Spain Abstract: Sequential compression devices and chemical prophylaxis are the standard venous thromboembolism (VTE) prevention for trauma patients with acetabular and pelvic fractures. Current chemical pharmacological contemplates the use of heparins or fondaparinux. Other anticoagulants include coumarins and aspirin, however these oral agents can be challenging to administer and may need monitoring. When contraindications to anticoagulation in high-risk patients are present, prophylactic inferior vena cava filters can be an option to prevent pulmonary emboli. Unfortunately strong evidence about the most effective method, and the timing of their commencement, in patients with pelvic and acetabular fractures remains controversial. Keywords: Acetabular, fracture, pelvic, prophylaxis, thromboembolism, trauma. INTRODUCTION associated with PE [15]. Several authors demonstrate that one in four PEs leads to mortality [16]. Hence, using Venous thromboembolism (VTE) is a prevalent and thromboprophylaxis adequately is an essential step in the severe disease compared with other public health problems management of the patients who sustain a pelvic fracture [1-4]. The reported incidence of deep vein thrombosis (DVT) [17]. after pelvic fractures varies according to patient demographics, the type of fracture, and the method of In spite of representing a high-risk population for DVT, detection [5, 6]. -
Identification of Pelvic Fragility Fractures at a University Teaching Hospital
10.7861/clinmed.20-2-s113 RESEARCH The truth behind the pubic rami fracture: identification of pelvic fragility fractures at a university teaching hospital Authors: Dawn van Berkel,A Orly Herschkovich,A Rachael Taylor,A Terence OngA and Opinder SahotaA Introduction Furthermore, 23 patients had acute pelvic fragility fractures identified on CT or MRI, in the presence of normal X-rays. In Older patients presenting on the acute medical take with pelvic these patients, further imaging showed that 70% had suffered fragility fractures (PFF) represent an increasing epidemic.1 The pubic rami fractures, 22% acetabular fractures, 74% sacral most common pelvic fracture identified by plain X-ray is that of the fractures and 22% ilium fractures. pubic rami.2 PFF are painful and despite optimal analgesia, many of these patients struggle to mobilise. Between 60% and 80% of patients have fractures of the posterior pelvic ring, namely of the Conclusion 3,4 sacrum, which are overlooked and not visible on plain X-ray. Pubic rami fragility fractures are a significant problem in Sacral fractures are unstable and load-bearing, thus increasing older people and often require admission to hospital. Further the likelihood of pain-dependent mobility reduction and the imaging confirms that these fractures are complex, with 5 risks that this poses in an older population. Minimally invasive co-existing fractures of the acetabulum and sacrum being sacroplasty is available and has been shown to improve pain- common. Findings also confirm that plain X-rays are a poor 6,7 related outcomes. We aimed to quantify the number of patients modality in the identification of pelvic fractures. -
12 Fractures of the Pelvis 239 12 Fractures of the Pelvis
12 Fractures of the Pelvis 239 12 Fractures of the Pelvis M. Tile tions, the results with simple treatment will be quite 12.1 different (Fig. 12.1). Therefore, in reading the litera- Introduction ture, we must be certain that we are not comparing apples with oranges or chalk with cheese. An under- In the past two decades, traumatic disruption of the standing of this injury is the key to logical decision pelvic ring has become a major focus of orthopedic making. interest, as has the care of polytraumatized patients. This injury forms part of the spectrum of polytrauma and must be considered a potentially lethal injury with mortality rates of 10%–20%. The stabilization 12.2 of the unstable pelvic ring in the acute resuscita- Understanding the Injury tion of multiply injured patients is now conventional wisdom. In order to better understand our proposed classi- With respect to the long-term results of pelvic fication and rationale of management, some knowl- trauma, conventional orthopedic wisdom held that edge of pelvic biomechanics is essential. surviving patients with disruptions of the pelvic ring The pelvis is a ring structure made up of two recovered well clinically from their musculoskeletal innominate bones and the sacrum. These bones have injury. However, the literature on pelvic trauma was no inherent stability, and the stability of the pelvic ring mostly concerned with life-threatening problems is thus due mainly to its surrounding soft tissues. and paid scant attention to the late musculoskeletal The stabilizing structures of the pelvic ring are the problems reported in a handful of articles published symphysis pubis, the posterior sacroiliac complex, prior to 1980. -
Pelvic Trauma: WSES Classification and Guidelines Federico Coccolini1*, Philip F
Coccolini et al. World Journal of Emergency Surgery (2017) 12:5 DOI 10.1186/s13017-017-0117-6 REVIEW Open Access Pelvic trauma: WSES classification and guidelines Federico Coccolini1*, Philip F. Stahel2, Giulia Montori1, Walter Biffl3, Tal M Horer4, Fausto Catena5, Yoram Kluger6, Ernest E. Moore7, Andrew B. Peitzman8, Rao Ivatury9, Raul Coimbra10, Gustavo Pereira Fraga11, Bruno Pereira11, Sandro Rizoli12, Andrew Kirkpatrick13, Ari Leppaniemi14, Roberto Manfredi1, Stefano Magnone1, Osvaldo Chiara15, Leonardo Solaini1, Marco Ceresoli1, Niccolò Allievi1, Catherine Arvieux16, George Velmahos17, Zsolt Balogh18, Noel Naidoo19, Dieter Weber20, Fikri Abu-Zidan21, Massimo Sartelli22 and Luca Ansaloni1 Abstract Complex pelvic injuries are among the most dangerous and deadly trauma related lesions. Different classification systems exist, some are based on the mechanism of injury, some on anatomic patterns and some are focusing on the resulting instability requiring operative fixation. The optimal treatment strategy, however, should keep into consideration the hemodynamic status, the anatomic impairment of pelvic ring function and the associated injuries. The management of pelvic trauma patients aims definitively to restore the homeostasis and the normal physiopathology associated to the mechanical stability of the pelvic ring. Thus the management of pelvic trauma must be multidisciplinary and should be ultimately based on the physiology of the patient and the anatomy of the injury. This paper presents the World Society of Emergency Surgery (WSES) classification of pelvic trauma and the management Guidelines. Keywords: Pelvic, Trauma, Management, Guidelines, Mechanic, Injury, Angiography, REBOA, ABO, Preperitoneal pelvic packing, External fixation, Internal fixation, X-ray, Pelvic ring fractures Background At present no comprehensive guidelines have been Pelvic trauma (PT) is one of the most complex manage- published about these issues. -
13 Fractures of the Acetabulum 291 13 Fractures of the Acetabulum
13 Fractures of the Acetabulum 291 13 Fractures of the Acetabulum M. Tile reading the literature to separate the apples from 13.1 the oranges, that is, to compare only similar fracture Introduction types (Fig. 13.1c). For example, in the article by Rowe and Lowell (1961), Fractures of the acetabulum are relatively uncom- closed methods using traction were recommended as mon, but because they involve a major weight-bear- the treatment of choice for acetabular fractures. How- ing joint in the lower extremity, they assume great ever, close scrutiny of this paper describing 93 fractures clinical importance. The principle of management in 90 patients revealed a large number of inconsequen- for this fracture is as for any other displaced lower tial fractures in older individuals with expected good extremity intra-articular fracture, namely, that ana- results, and, in examining the high-energy injuries, 26 tomical reduction is essential for good long-term involved the superior weight-bearing dome of the ace- function of the hip joint. In some cases, anatomi- tabulum. When anatomical reduction was obtained, 13 cal reduction may be obtained by closed means, but of 16 had a good result, but when anatomical reduction more often, open reduction followed by stable inter- of the dome fragment was not obtained, ten out of ten nal fixation allowing early active or passive motion had a poor result. Of the posterior wall fractures, of will be required. In the past, the achievement of this which there were 17, closed management led to poor ideal, that is, anatomical reduction, has been difficult results in six out of nine cases, whereas open manage- because of technical problems such as those caused ment led to good results in eight out of eight cases. -
A Case of Maternal Pelvic Trauma Following a Road Traffic Accident, Associated with Fetal Intracranial Haemorrhage
Case reports 115 J Accid Emerg Med: first published as 10.1136/emj.14.2.115 on 1 March 1997. Downloaded from A case of maternal pelvic trauma following a road traffic accident, associated with fetal intracranial haemorrhage Geoffrey Matthews, Beth Hammersley Abstract procedure of the American College of Sur- Maternal pelvic injury resulting from geons. Her airway was intact, and she was able road traffic accidents may cause fetal to speak (complaining of severe pain in her intracranial haemorrhage. A case is de- right hip). Her blood pressure was 150/90 and scribed. Caesarean section should be con- she had a pulse of 1 10 beats/min. There was no sidered in acute trauma. clinical evidence of abdominal, chest, or head (7Accid Emerg Med 1997;14:1 15-117) injury, and there was no history of head injury or loss of consciousness. Cervical spine, chest x Keywords: road traffic accident; pregnancy; fetal intra- ray, and x ray of the right femur were all cranial haemorrhage. normal. The patient had noticed fluid draining vaginally since the accident and was now con- Road traffic accidents are major causes of tracting 1 in 4. There was pain on any attempt trauma in pregnancy.' Maternal injuries in- at moving the right leg, particularly in the clude pelvic fractures, which are associated region of the right hip; the other limbs were with fetal intracranial trauma. normal. The uterine fundus was soft (between Review of published reports over the past 30 contractions), with a symphysial-fundal height years suggests a high fetal death rate in associ- consistent with 39 weeks. -
Unstable Pelvic Injuries a Life Or Death Emergency with a Case Presentation
UNSTABLE PELVIC INJURIES A LIFE OR DEATH EMERGENCY WITH A CASE PRESENTATION Timothy S. Arnett BS, NREMT-P Captain, Anne Arundel County Fire Department Mechanism of Injury Review anatomy of the pelvis and the vessels that pass through it Identify the different types of pelvic fractures and how they are caused. Discuss the traumatic nature of pelvic injuries and why they are a life or death emergency. Discuss the pelvic binder and it’s proper placement Identify the treatment of pelvic injuries both pre-hospital and at the trauma center. Katelyn Morrison case study OBJECTIVES TYPES OF PELVIC FRACTURES RED arrow shows the direction of force applied. Lateral compression fractures are most likely seen in falls and vehicle crashes AP compression fractures are more likely to be motorcycle, ATV, bikes crashes or vehicle crashes where the force is from a specific object Vertical shear fractures are most likely the result of severe impact to one leg or another. This could come from falls where they land on their feet or crashes where the patient had their feet and legs elevated Sacral Fracture Malgaigne fracture is an unstable type of pelvic fracture, which involves one hemipelvis, and results from vertical shear energy vectors. Organs near pelvis Parts of digestive system Reproductive organs Bladder and urethra Blood Vessels run through and around Right and left iliac arteries from off aorta Right and left iliac veins returning from legs Blood vessels supplying pelvis and tissues around pelvis ANATOMY AROUND PELVIS VASCULATURE AND NERVES Many arteries and veins both pass through as well as feed the pelvic area. -
Treatment of Acetabular Fractures in Adolescents
An Original Study Treatment of Acetabular Fractures in Adolescents Milan K. Sen, MD, Stephen J. Warner, MD, PhD, Nicholas Sama, MD, Martin Raglan, MD, Charles Bircher, MD, Martin Bircher, MD, Dean G. Lorich, MD, and David L. Helfet, MD Abstract Although the treatment of acetabular fractures in adults latest follow-up, 29 had no pain, and 6 had mild intermit- has evolved substantially, treatment of these injuries in tent pain not limiting activity. adolescents remains primarily nonoperative. ORIF was found to be safe and to result in predictable We performed a retrospective review to evaluate out- union. We therefore advocate a more aggressive strategy. comes of treatment of adolescent acetabular fractures. We Given our low complication rate, we recommend nonop- identified 38 adolescent acetabular fractures (patient ages, erative management only for stable, minimally displaced 11-18 years), all treated by an experienced trauma surgeon. fractures (<1 mm). Unstable fractures, fractures with any Open reduction and internal fixation (ORIF) was performed hip subluxation, and fractures displaced more than 1 mm in 37 cases, and 1 case was treated nonoperatively. should be managed with ORIF. Mean follow-up was 38.2 months. All fractures healed. As reported in adults, articular injury often is associated Reduction was anatomical in 30 cases, imperfect in 7. with secondary degenerative arthritis. This association is One patient had surgical secondary congruence, 1 had expected in adolescents as well. Given adolescents’ life preoperative deep vein thrombosis, 1 developed a deep expectancy subsequent to injury and surgery, any late infection, and 2 had femoral head avascularAJO necrosis and posttraumatic arthritis will have a significant impact on developed posttraumatic arthritis (both had hip disloca- quality of life over the long term, with increased duration tions). -
Unusual Mechanism for Acetabular Fracture: a Missed Diagnosis
UNUSUAL MECHANISM FOR ACETABULAR FRACTURE: A Ahmad M, A Port MISSED DIAGNOSIS. Middlesborough, UK EARLY CLINICAL EXPERIENCE WITH THE LESS INVASIVE Ahmad M, A Bajwa, M Khatri, A Port STABILISATION SYSTEM (LISS) IN THE TREATMENT OF Middlesborough, UK COMPLEX DISTAL FEMORAL & PROXIMAL TIBIAL FRACTURES DORSAL COMPRESSIVE MANEUVER IN MORTON´S NEUROMA Álvarez Luque A, D Bernabeu Taboada, C SONOGRAPHIC EXAMINATION Martín Hervás, C Castillo, F López Barea Madrid, Spain BONE IMAGING FEATURES IN THALASSEMIA Alymlahi E, R Dafiri Rabat, Morocco PAEDIATRIC MANIFESTATIONS OF LANGERHANS Alymlahi E, R Dafiri CELL HISTIOCYTOSIS: A REVIEW OF THE CLINICAL AND THE Rabat, Morocco RADIOLOGICAL FINDINGS IMAGING OF CHONDROSARCOMA Alymlahi E, L Hammani, F Imani Rabat, Morocco US AND MRI DIAGNOSIS OF BILATERAL AND SIMULTANEOUS Andipa E, K Liberopoulos, Z Nikolakopoulou, RUPTURE OF THE QUADRICEPS AND PATELLAR TENDON P Brestas, G Zois Athens, Greece IMAGING DIAGNOSIS OF STRESS BONE FRACTURES Aparisi P, M Abadal , M San Martín, L Canales Barcelona, Spain MRI CHARACTERISTICS OF DISTANT METASTASIS OF SOFT Argin M., R Arkun, A Oktay, T Akalin, D TISSUE SARCOMAS Sabah Izmir, Turkey HIGH-RESOLUTION ULTRASOUND OF TARSAL TUNNEL Bacigalupo L, R Podestà, G Succio, M Rubino, SYNDROME S Bianchi, C Martinoli Genova, Italy / Chenes Bougeries, Switzerland A NOVEL VACUUM IMMOBILIZATION DEVICE AND A NOVEL Bale RJ, M Vogele, T Lang, P Kovacs, M TARGETING DEVICE FOR COMPUTER ASSISTED Freund, F Rachbauer, C Hoser, C Fink, B INTERVENTIONAL PROCEDURES Dolati, R Rosenberger, W Jaschke -
Trochanteric Osteotomy for Incarcerated Hip Dislocation Due to Interposed Posterior Wall Fragments Jeffrey O
2ang.qxd 2/10/04 11:09 AM Page 213 FEATURE ARTICLE Trochanteric Osteotomy for Incarcerated Hip Dislocation Due to Interposed Posterior Wall Fragments Jeffrey O. Anglen, MD Michael Hughes Abstract A series of 12 patients was retrospectively reviewed to ly longer operations with more blood loss. Patients with evaluate the use of sliding trochanteric osteotomy for osteotomy tended toward a higher incidence of post- reduction of hip dislocations that were irreducible due to traumatic arthritis, but Harris hip scores at 2 years were interposed posterior wall fragments. Compared to simi- identical to matched comparisons. No adverse effects of lar patients who did not have irreducible dislocation or trochanteric osteotomy were identified. trochanteric osteotomy, the 12 patients had significant- Incarcerated hip dislocation is a severe ular fracture were identified through a gent operation (Figure 1). When they injury with poor prognosis. When the search of the Orthopaedic Trauma Service could not be taken directly to the operat- reduction is blocked by fragments of a database at the University of Missouri ing room, skeletal traction was applied. comminuted posterior wall, forceful Health Sciences Center, a level 1 trauma Trochanteric osteotomy was an intraoper- repeated attempts at reduction, pre- or center. All patients were operated on by a ative decision. intraoperatively, may further damage the single, fellowship-trained orthopedic With the early patients in this series, a articular surface. Trochanteric osteotomy traumatologist. Charts and radiographs variety of maneuvers were attempted during the surgical exposure of such cases were reviewed by a research assistant prior to osteotomy, including forceful has been found to facilitate reduction and who was uninvolved in the care of the manipulations of the leg, hip rotation with lessen trauma to the joint. -
Trauma Patient Triage Definitions
TRAUMA PATIENT TRIAGE DEFINITIONS Trauma Triage Since patients differ in their initial response to injury, trauma triage is an inexact science. Current patient identification criteria does not provide 100% percent sensitivity and specificity for detecting injury. As a result, trauma systems are designed to over-triage patients in order not to miss a potentially serious injury. Under- triage of patients should be avoided since a potentially seriously injured patient could be delivered to a facility not prepared to manage their injury. Large amounts of over-triage is not in the best interest of the Trauma System since it will potentially overwhelm the resources of the facilities essential for the management of severely injured patients. Priority 1 Trauma Patients These are patients with high energy blunt or penetrating injury causing physiological abnormalities or significant single or multisystem anatomical injuries. These patients have time sensitive injuries requiring the resources of a designated Level I, Level II, or Regional Level III Trauma Center. These patients should be directly transported to a Designated Level I, Level II, or Regional Level III facility for treatment but may be stabilized at a Level III or Level IV facility, if needed, depending on location of occurrence and time and distance to the higher level trauma center. If needed these patients may be cared for in a Level III facility if the appropriate services and resources are available. Physiological Compromise Criteria: Hemodynamic Compromise-Systolic BP <90 mmHg Other signs that should be considered include: o Sustained Tachycardia o Cool diaphoretic Skin Respiratory Compromise-RR<10 or >29 Breaths/Minutes Or <20 in infant <1 year Altered Mentation- of trauma etiology- GCS <14 Anatomical Injury Criteria Penetrating injury of head, neck, chest/abdomen, or extremities proximal to elbow or knee.