A case of traumatic hemipelvectomy

Management of partial traumatic hemipelvectomy

Partial traumatic hemipelvectomy is a devastating condition. Although by definition the affected limb is not totally transected from the trunk because of retained soft tissue, the reported mortality rate is actually higher than in complete traumatic hemipelvectomy. Between January 2000 and December 2011, a total of 917 patients were admitted to the authors' institution for pelvic fracture. Seven of these patients met the criteria for partial traumatic hemipelvectomy. All 7 patients had multiple associated injuries and met the criteria for Baskett class IV hypovolemic shock on arrival at the emergency department. The amount of bleeding was the greatest issue, and control of hemorrhage and rapid blood transfusion were the initial goals. Abdominal aorta balloon occlusion, laparotomy and packing, and pelvic external fixation were useful to control bleeding. Two patients died during the initial resuscitation phase. Angiography (digital subtraction or computed tomographic) was performed in 4 patients but did not provide any treatment-altering information. Limb preservation was attempted in 2 patients; both of these patients eventually required hindquarter amputation. One patient died, and the second patient survived after a difficult postoperative course. The best results were obtained in 3 patients who underwent completion of the hindquarter amputation within 24 hours of trauma. All patients became wheelchair dependent, and no patient was able to return to work. Early completion of hindquarter amputation after hemorrhaging has been controlled is recommended in patients with partial traumatic hemipelvectomy. Angiography did not prove useful in decision making.

Late presentation with whole limb gangrene following open traumatic hemipelvectomy

Traumatic hemipelvectomy is a rare type of devastating injury with a very high mortality rate and often the result of high energy transfer trauma. Most patients, who survive this injury, do so on the basis of prompt and immediate advanced medical care. Abdominal and pelvic visceral injuries are frequently seen in those cases that survive. We present an unusual case of a 17-year-old patient who survived this injury after presenting 4 days following a motor cycle crash with whole limb gangrene and clinical evidence of septicaemia and without associated abdominal and pelvic visceral injury. She had successful management of her wound and was rehabilitated with axillary crutches and without a prosthetic limb due to financial constraints. The possible mechanism of injury was reviewed and peculiarities of management of this case in our environment were highlighted.