Traumatic Hemipelvectomy

Labler, Ludwig ; Trentz, Otmar ; Keel, Marius

In: European Journal of Trauma, 2005, vol. 31, no. 6, p. 543-550

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    Summary
    Purpose:: Open or closed traumatic hemipelvectomy is defined as a uni- or bilateral avulsion of the bony hemipelvis in combination with rupture of the large pelvic nerves and vessels and is usually accompanied by injuries 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 hemipelvectomy, 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 transferred 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 unilateral in eight patients with one complete avulsion and bilateral in one patient. Injuries of the pelvic vessels occurred in all patients. Most of the patients had injuries of both the genitourinary tract and the intestine. Associated injuries were mostly those of extremities, thorax and head. Neurologic deficits could be documented clinically on admission in four patients. Laparotomy for damage control with packing of the abdominal cavity and the retroperitoneum was performed in all cases. Four patients died during stabilization 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 complications. Two patients survived with a follow-up of 21 and 34 months. Conclusion:: Traumatic hemipelvectomy is a most severe pelvic ring injury. If the diagnosis of traumatic hemipelvectomy is clear, surgical hemipelvectomy should be performed. Limb-saving procedures endanger patient's life. Early and frequent second-look operations and aggressive management of associated pelvic injuries minimize wound problems and septic complications