DOCSLIB.ORG

Open Pelvic Fracture with Vaginal Laceration and Arterial Injury in a Pediatric Patient Lisa K

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Open Pelvic Fracture with Vaginal Laceration and Arterial Injury in a Pediatric Patient Lisa K (aspects of trauma) Open Pelvic Fracture With Vaginal Laceration and Arterial Injury in a Pediatric Patient Lisa K. Cannada, MD, John F. Scovell, MD, Brent Bauer, MD, and David A. Podeszwa, MD pen pelvic fractures occur CASE REPORT was identified, and a palpable and in up to 3% to 5% of all An unrestrained backseat passenger, Doppler pulse was present proxi- adult pelvic fractures.1,2 a 3-year-old girl, was ejected during mally, but a significant change in the OThe incidence is even a collision of motor vehicles. She Doppler pulse was detected distally. lower in pediatric pelvic fractures. was transferred from the accident The middle portion of the vessel Open pelvic fractures in children are scene to our hospital. On arrival, appeared bruised. The iliac artery reported as small series or isolated she was awake and alert (Glasgow was opened distal to the middle por- case reports. Open pelvic fractures Coma Scale score, 15). An unstable tion, and a brisk back-flow from the are known to be associated with pelvis was noted. The patient had leg was noted. The injury to the ves- many other severe injuries.1-7 Pelvic a complicated wound involving the sel was 4 cm long. A No. 6 carotid fractures in pediatric patients differ right inguinal region extending to the shunt was used to bypass the injured significantly from those in adults.3,8 perineum. The wound was grossly zone of the vessel. Immediately, the The ability of the pediatric pelvis to contaminated with dirt and debris. right lower extremity became pink, deform plastically—a result of the The right lower extremity was cold and palpable pulses were present in elasticity of the pediatric bone and and pulseless. the right foot. Ischemic time was the presence of more cartilaginous During physical examination, approximately 1.5 hours from time structures—leads to its absorbing the patient could move the right of injury. significantly more energy before foot and had sensation in the right With blood flow restored to the breaking. Therefore, presence of a lower extremity. An anteroposterior right lower extremity, the orthopedic pelvic fracture in a pediatric trauma (AP) pelvic radiograph showed a team then addressed the pelvic dias- patient should heighten suspicion pubic diastasis of greater than 8 cm. tasis. We placed 4-mm stainless steel for other significant injuries. Fractures of the right pubic rami and half-pins into the superior crest of This is the first known English- ilium were also identified (Figure 1). the iliac wings bilaterally, and place- literature report of an open pelvic The bladder appeared normal, and ment was confirmed by fluoroscopy. fracture sustained with vaginal lacer- there was no extravasation when nor- An external fixation frame (Synthes, ation and internal iliac artery injury. mal saline was flushed through the Paoli, Pennsylvania) was construct- The patient’s guardians provided patient’s Foley catheter. ed, and the pelvis was reduced. written informed consent for print The patient was emergently taken With the external fixator in place, and electronic publication of this to the operating room. She received the pediatric surgeons proceeded case report. IV cefazolin 400 mg and IV gen- with the external iliac repair. A tamicin 40 mg. The femoral vessel 3.5 mm polytetrafluoroethylene graft Dr. Cannada is Associate Professor, on the right was identified and no was used to complete the repair. Department of Orthopaedic Surgery, pulse was present on direct examina- After vessel repair, the other inju- Saint Louis University, St. Louis, Missouri. Dr. Scovell is Orthopedic Surgeon, tion or Doppler signal. The proximal ries were addressed. A laparotomy Lubbock Sports Medicine, Lubbock, portion of the external iliac artery was performed, and a through-and- Texas. Dr. Bauer, at the time of this writing, was Orthopedic Resident, University of Texas Southwestern, Dallas, Texas. Dr. Podeszwa is Assistant Professor, University of Texas Southwestern. Address correspondence to: Lisa K. Cannada, MD, Department of Orthopaedic Surgery, Saint Louis University, 3635 Vista Ave, 7th Floor, St. Louis, MO 63110 (tel, 314-577-8850; fax, 314-268-5121; e-mail, [email protected]). Am J Orthop. 2011;40(8):415-417. Copyright Quadrant HealthCom Inc. 2011. All rights reserved. Figure 1. Anteroposterior radiograph shows open-book pelvic fracture. www.amjorthopedics.com August 2011 415 Open Pelvic Fracture vehicle.3,4,7-9 It has been reported that symphysis widening is normally 10 mm to 12 mm within the first 3 years, compared with 2 mm to 4 mm in adults.4 Clearly, our patient had significantly more widening than what is considered a normal variant. In a 12-year review, Spiguel and colleagues5 found pelvic fractures Figure 2. Immediate postoperative radiograph shows pelvic reduction. in 13 of 2850 pediatric admissions. Eight of the 13 patients (62%) pre- through injury to the rectum and an sented with an associated injury, but injury to the rectal sphincter complex no patient had an open pelvic frac- Figure 3. Anteroposterior radiograph of were noted. These injuries required a pelvis at 29-month follow-up. ture. The pediatric pelvis is shal- diverting colostomy. Next, the exten- low compared with the adult pelvis sive wounds involving the perineum tive course. Clindamycin was used and offers less bony protection to were repaired. There was a lacera- to manage the drainage. When the the abdominal and pelvic system tion from the right crus of the clito- patient was discharged home with throughout. Thus, there may be an ral hood along the bulbocavernosus a peripherally inserted central cath- increased incidence of intra-abdom- muscle, in addition to a laceration eter on PTD 11, ESR was 49 mm/h, inal or intrapelvic injuries.5,10 along the edge of the introitus of CRP was 2.2 mg/dL, and there The largest series of pediatric the vagina, through the transverse were no clinical signs of infection. open pelvic fractures was reported perineal muscles and into the peri- For 8 weeks, the patient remained by Mosheiff and colleagues.2 In their neal body and along the right anal non–weight-bearing on the bilateral retrospective study, they identified sphincter. Digital examination dem- lower extremities. The pelvic external 15 patients treated over a 12-year onstrated a defect into the body of fixation was removed 8 weeks after period. Mortality of open pelvic the fourchette of the vagina, and this surgery. The colostomy was reversed fractures was 20%. Ten of the 15 was repaired. 4 months after injury. patients (67%) presented with unsta- The patient tolerated the proce- At the latest orthopedic follow-up, ble type III or type IV pelvic frac- dure well. After it was completed, she 29 months after injury (Figure 3), tures (Torode and Zieg classifica- was taken to the intensive care unit the patient’s mother reported that tion of pelvic fractures). Ten patients and remained intubated. She was in the girl had no complaints of pain, (67%) had severe superficial soft- stable condition. Postoperative radio- no activity limitation, and no geni- tissue injuries in the immediate area graphs showed the fracture reduc- tourinary complaints. The patient around the pelvis, and 12 patients tion (Figure 2). Heparin infusion for had normal gait and no leg-length (80%) had injuries in the anal-rectal- graft preservation was started, but discrepancy. She had symmetric hip genitourinary region. Concomitant the inpatient postoperative course range of motion with flexion of head, chest, and extremity injuries became complicated. Less than 24 more than 110°, internal rotation of are commonly associated with pelvic hours after surgery, hemoglobin level 45°, and external rotation of 65° and fractures; however, in this series of dropped to 4.9 g/dL. Heparin infu- abduction of 65°. open pelvic fractures, only 2 patients sion was discontinued, and the patient had additional injuries. was transfused. Reexploration of the DISCUSSION Vaginal lacerations can occur in groin region revealed continued retro- Pelvic fractures in children are open or closed pelvic fractures. A peritoneal bleeding. The bleeding was not common. In a review of the 10-year retrospective review of 114 controlled. National Pediatric Trauma Registry, female patients with pelvic fractures The patient was extubated on the number of pediatric pelvic frac- found a 3.5% incidence of vaginal posttrauma day (PTD) 2. On PTD tures over a 5-year period was found lacerations.11 For most adult vaginal 6, there was copious serous drain- to represent 3% of pediatric trauma lacerations, management includes age from the right groin wound. patients, or half the frequency in debridement and primary surgi- The patient was afebrile but had adults.1 In many series of pediatric cal closure or vaginal packing with an elevated erythrocyte sedimenta- pelvic fractures, the open-book frac- antibiotic coverage. Complications tion rate (ESR) of 49 mm/h and ture is extremely rare, and often is of delayed management of unrecog- C-reactive protein (CRP) of 3.6 not even mentioned. The most com- nized vaginal lacerations in children mg/dL. White blood cell count mon mechanism of injury for pelvic have been reported to include vaginal remained stable, around 10,000/ fractures is blunt trauma; most fre- stricture, dyspareunia, osteomyelitis, mm3, throughout the postopera- quently, a child is struck by a motor and pelvic abscess.6 416 The American Journal of Orthopedics® www.amjorthopedics.com L. K. Cannada et al There is a paucity of literature internal iliac artery injury in the frac- AUTHORS’ DISCLOSURE regarding long-term follow-up of tured pelvis of an 8-year-old patient. STATEMENT pediatric pelvic fractures. In a pro- Hit by a motor vehicle, the child The authors report no actual or spective multicenter study of func- had sustained multiple fractures of potential conflict of interest in rela- tional outcomes, Signorino and col- the pelvis and femur along with a tion to this article.
Load more

Recommended publications
  • 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.
    [Show full text]
  • 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.
    [Show full text]
  • 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.
    [Show full text]
  • 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.
    [Show full text]
  • 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.
    [Show full text]
  • 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.
    [Show full text]
  • Lesions Associated with Pelvic Fracture
    Review Article iMedPub Journals ARCHIVES OF MEDICINE 2017 http://www.imedpub.com/ Vol.9 No.3:3 ISSN 1989-5216 DOI: 10.21767/1989-5216.1000218 Lesions Associated with Pelvic Fracture: An Integrating Literature Review Nauã Rodrigues de Souza1*, Daniela de Aquino Freire1, Clarissa Mourão Pinho1, Gabriela Lopes de Almeida1, Franciene Marilia Elias dos Santos2, Katiane Santana dos Santos2, Eudanusia Guilherme de Figueiredo3, Maria do Bom Parto de Oliveira3, Marcos Antônio de Oliveira Souza1, Igor Cavalcanti Ferraz1, Magaly Bushatsy4 and Isabel Cristina Ramos Vieira Santos4 1Department of Nursing, Pernambuco State University, Paraíba State University, Recife/PE, Brazil 2Department of Nursing, Emergency Specialist, Pernambuco State University, Recife/PE, Brazil 3Department of Nursing, Specialist in Oncology at the Oswaldo Cruz University Hospital, Pernambuco State University, Recife/PE, Brazil 4Department of Nursing, Nossa Senhora das Graças School of Nursing, Pernambuco State University, Recife/PE, Brazil *Corresponding author: Nauã Rodrigues de Souza, University of Pernambuco, UPE. R. Arnóbio Marquês, 310. University of Pernambuco/State University of Paraíba, Bairro Santo Amaro. Recife, Pernambuco, Brazil, Tel: +55-81-3423-6433; E-mail: [email protected] Received date: June 03, 2017; Accepted date: June 09, 2017; Published date: June 12, 2017 Citation: De Souza NR, Freire D, Pinho CM, De Almeida GL, Elias dos Santos FM, et al. Lesions Associated with Pelvic Fracture: An Integrating Literature Review. Arch Med. 2017, 9:3 Copyright: © 2017 De Souza NR. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
    [Show full text]
  • Pelvic Fragility Fractures an Opportunity to Improve the Undertreatment of Osteoporosis
    213 COPYRIGHT Ó 2020 BY THE JOURNAL OF BONE AND JOINT SURGERY,INCORPORATED A commentary by Paul A. Anderson, MD, is linked to the online version of this article at jbjs.org. Pelvic Fragility Fractures An Opportunity to Improve the Undertreatment of Osteoporosis Christian T. Smith, MS, David W. Barton, MD, Amit S. Piple, BS, and Jonathan J. Carmouche, MD Investigation performed at the Virginia Tech Carilion School of Medicine, Roanoke, Virginia Background: Osteoporosis is often undiagnosed until patients experience fragility fractures. Pelvic fractures are com- mon but underappreciated sentinel fractures. Screening patients with a pelvic fracture for osteoporosis may provide an opportunity to initiate appropriate treatments such as anti-osteoporosis therapy to prevent additional fractures. Methods: This retrospective cohort review examined the management of osteoporosis after pelvic fractures at a large tertiary care center without an established secondary fracture prevention program. Data were extracted from electronic medical records of all new patients with a pelvic fracture who were ‡50 years of age from this center and its affiliated community hospitals from 2008 to 2014. Outcome measures included the initiation of anti-osteoporosis therapy before the fracture, within the year following the fracture, >1 year following the fracture, or never and new osteoporotic fractures within 2 years after a pelvic fracture. Results: From 2008 to 2014, 947 patients presented with pelvic fractures. Of these patients, 27.1% (257 patients) were taking anti-osteoporosis medications before the fracture. Four percent of treatment-na¨ıve patients began anti- osteoporosis therapy within 1 year of fracture, with 1.2% (11 patients) starting after 1 year.
    [Show full text]
  • System Specific Trauma
    MODULE 3 System Specific Trauma | Emergency and Essential Surgical Care (EESC) programme 1 www.who.int/surgery OBJECTIVES FOR MODULE 3 To learn specific management strategies for trauma • Head • Spine and spinal cord • Chest • Abdomen • Female genitalia • Musculoskeletal system | Emergency and Essential Surgical Care (EESC) programme 2 www.who.int/surgery Head Injury | Emergency and Essential Surgical Care (EESC) programme 3 www.who.int/surgery HEAD INJURY • Altered level of consciousness is a hallmark of acute cerebral trauma • Never assume that substances (alcohol or drugs) are causes of drowsiness • Frequent clinical mistakes: – Incomplete ABC's, priority management – Incomplete primary, secondary surveys – Incomplete baseline neurologic examination – No reassessment of neurologic status | Emergency and Essential Surgical Care (EESC) programme 4 www.who.int/surgery HEAD INJURY Basal skull fractures – Periorbital ecchymosis (racoon eyes) – Mastoid ecchymosis (Battle's sign) – Cerebrospinal fluid leak from ears or nose Depressed skull fracture – Fragments of skull may penetrate dura, brain Cerebral concussion – Variable temporary altered consciousness | Emergency and Essential Surgical Care (EESC) programme 5 www.who.int/surgery HEAD INJURY Intracerebral hematoma – Caused by acute injury or delayed, progressive bleeding originating from contusion Clinical features of increased intracranial pressure: – Decreased level of consciousness – Bradycardia – Unequal or dilated pupils – Seizures – Focal neurologic deficit | Emergency and Essential
    [Show full text]
  • Avoiding Complications in Acetabular and Pelvic Fractures
    Avoiding Complications in Acetabular and Pelvic fractures Kenneth Graf, MD Director of Orthopedic Trauma Cooper University Health Systems Acetabular fractures Epidemiology: Bimodal distribution: high energy often in young patients Low energy in elderly patients Lower extremity injury most common associated injury- 36% 80% hip survival with well treated acetabular fracture Male >Female, ? anatomy Acetabulum anatomy CT differentiation Acetabular Fractures Risk factors for poor outcome: NON ANATOMICAL REDUCTION (2mm) Age >40yo. Risk for poor outcome increases directly wit age Posterior fracture patterns and associated fracture patterns – transverse-posterior wall the worst outcomes of letournel classifications Delayed hip reduction > 12 hours Femoral head injury Post Traumatic Arthritis Directly related to quality of reduction-89% excellent to good with anatomic reduction 53% poor outcomes with poor reduction Highest risk with transverse posterior wall Elderly highest risk for loss of reduction Articular injury to femoral head-hip cannot be salvaged by anatomical reduction of acetabulum Treatment Goals 1. Multiple studies confirm best predictor of successful treatment of acetabular fractures is obtaining and maintaining a quality reduction <2mm= 13% post traumatic arthrosis >2mm= 43% post traumatic arthrosis Improving reduction Time to ORIF- sooner is better Better reductions with quicker time to OR. Decrease nosocomial contamination and infection rates Prone vs lateral- no difference proven, possible higher infection
    [Show full text]
  • Trauma and Environmental Emergencies Rapid Review
    TRAUMA AND ENVIRONMENTAL EMERGENCIES RAPID REVIEW 1. Basic formulas a. Total body water (TBW) Weight (kg) x 0.6 b. Water deficit TBW [1-desired Na ÷ current Na] c. Parkland 4 mL/kg/ % burn d. A-a gradient 140 – (PaO2 + PaCO2) e. MAP DBP + [{SBP – DBP} ÷ 3] f. ET tube size Age ÷ 4 + 4 g. Sed rate Age ÷ 4 + 4 h. Anion gap Na – [Cl + HCO3] i. Osmolar gap 2 x Na + BUN ÷ 2.8 + BS ÷ 18 2. Why we teach associations a. They state the scenario b. Try to simulate real life c. But… i. It is their perception of real life ii. Cannot ask additional questions iii. Cannot examine patient iv. Cannot order additional tests d. So they give typical or classic scenarios or give associations 3. Traumatic brain injuries a. Diffuse axonal injury (DAI) i. Prolonged coma (weeks); death from ICP 2° cerebral edema; indistinct grey- white margins and no mass on CT b. Subdural hematoma i. Bridging veins tear/rupture ii. Crescent-shaped lesion on CT iii. Older on coumadin, may see nothing on CT c. Traumatic subarachnoid hemorrhage i. Most common form of injury in moderate-to-severe TBI d. Epidural hematoma i. Associated with parietal or temporal skull fractures ii. Classic: LOC → lucid → LOC iii. Lens-shaped lesion on CT iv. Middle meningeal artery tear 4. Herniation a. Uncal – most common i. Ipsilateral fixed/dilated pupil, contralateral motor paralysis TRAUMA AND ENVIRONMENTAL EMERGENCIES RAPID REVIEW Page 1 ii. Transtentorial – less common a) Bilateral pinpoint pupils, bilateral Babinskis, increased tone then decorticate posturing, death b.
    [Show full text]
  • [Orth],Mch, FRACS, FICMR Fracture of the Pelvis Anatomy
    Vasu Pai D orth, MS, Nat Board [orth],MCh, FRACS, FICMR Fracture of the Pelvis Anatomy The pelvis is a ring-like structure of bones at the lower end of the trunk. The two sides of the pelvis are actually three bones (ilium, ischium, and pubis) that grow together as people age. Strong connective tissues (ligaments) join the pelvis to the large triangular bone (sacrum) at the base of the spine. This creates a bowl-like cavity below the rib cage. On each side, there is a hollow cup (acetabulum) that serves as the socket for the hip joint. Many digestive and reproductive organs are located within the pelvic ring. Large nerves and blood vessels that go to the legs pass through it. The pelvis serves as an attachment point for muscles that reach down into the legs and up into the trunk of the body. With all of these vital structures running through the pelvis, a pelvic fracture can be associated with substantial bleeding, nerve injury, and internal organ damage. Cause Growing teens, especially those involved in sports, are one group of people at risk for a particular type of pelvic fracture. Many "pulled muscles" may actually be undetected avulsion fractures of the pelvis. These fractures usually occur with sudden muscle contractions. A small piece of bone from the ischium where the hamstring muscles attach is torn away by these muscles. This type of fracture does not make the pelvis unstable or injure internal organs. Also at risk for pelvic fractures are elderly people with osteoporosis. An individual may fracture the pelvis during a fall from standing, such as when getting out of the bathtub or descending stairs.
    [Show full text]