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Spinuzza N, McHugh TR, Garland JS, Roddy WT, Hewitt MA, Harrington CJ, Thaper A, Reini J, Smith DG, Pasquina PF. The lived experience of military beneficiaries with amputations at the hip and pelvic level. Prosthet Orthot Int 2024; 48:337-343. [PMID: 38857166 DOI: 10.1097/pxr.0000000000000338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 12/21/2023] [Indexed: 06/12/2024]
Abstract
BACKGROUND Hip- and pelvic-level amputations are devastating injuries that drastically alter patient function and quality of life. This study examined the experience of military beneficiaries with a hip- or pelvic-level amputation to better characterize their challenges and specific needs and to optimize treatment in the future. METHODS We conducted a retrospective review of the Military Health System and identified 118 patients with a history of one or more amputation(s) at the hip or pelvic level between October 2001 and September 2017. Surviving participants (n = 97) were mailed a letter which explained the details of the study and requested participation in a telephonic interview. A total of six individuals (one female, five males) participated in structured interviews. RESULTS The study group included four participants with hip disarticulations and two participants with hemipelvectomies (one internal, one external). All six participants reported significant challenges with activities related to prosthetic use, mobility, residual limb health, pain, gastrointestinal and genitourinary function, psychiatric health, and sexual function. CONCLUSIONS These interviews highlight the unique needs of individuals with hip- and pelvic-level amputations and may improve access to higher echelons of care that would enhance the function and quality of life for these participants.
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Affiliation(s)
- Nicholas Spinuzza
- Department of Physical Medicine and Rehabilitation, The Center for Rehabilitation Sciences Research, Uniformed Services University of Health Sciences, Bethesda, MD
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD
| | - Terrence R McHugh
- Department of Physical Medicine and Rehabilitation, The Center for Rehabilitation Sciences Research, Uniformed Services University of Health Sciences, Bethesda, MD
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Jared S Garland
- Department of Physical Medicine and Rehabilitation, The Center for Rehabilitation Sciences Research, Uniformed Services University of Health Sciences, Bethesda, MD
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - William T Roddy
- Department of Physical Medicine and Rehabilitation, The Center for Rehabilitation Sciences Research, Uniformed Services University of Health Sciences, Bethesda, MD
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Melissa A Hewitt
- Department of Physical Medicine and Rehabilitation, The Center for Rehabilitation Sciences Research, Uniformed Services University of Health Sciences, Bethesda, MD
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Colin J Harrington
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD
| | - Akshay Thaper
- Department of Physical Medicine and Rehabilitation, The Center for Rehabilitation Sciences Research, Uniformed Services University of Health Sciences, Bethesda, MD
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Josh Reini
- Department of Physical Medicine and Rehabilitation, The Center for Rehabilitation Sciences Research, Uniformed Services University of Health Sciences, Bethesda, MD
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Douglas G Smith
- Department of Physical Medicine and Rehabilitation, The Center for Rehabilitation Sciences Research, Uniformed Services University of Health Sciences, Bethesda, MD
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Paul F Pasquina
- Department of Physical Medicine and Rehabilitation, The Center for Rehabilitation Sciences Research, Uniformed Services University of Health Sciences, Bethesda, MD
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD
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2
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Herold J, Notov D, Reeps C, Schaser KD, Kamin K, Mäder M, Kleber C. Limb salvage in traumatic hemipelvectomy: case series with surgical management and review of the literature. Arch Orthop Trauma Surg 2023; 143:6177-6192. [PMID: 37314526 PMCID: PMC10491572 DOI: 10.1007/s00402-023-04913-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 05/19/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND Traumatic hemipelvectomies are rare and serious injuries. The surgical management was described in several case studies, with primary amputation often performed to save the patient's life. METHODS We report of two survivors with complete traumatic hemipelvectomy resulting in ischemia and paralyzed lower extremity. Due to modern emergency medicine and reconstructive surgery, limb salvage could be attained. Long-term outcome with quality of life was assessed one year after the initial accident. RESULTS AND CONCLUSIONS The patients were able to mobilize themselves and live an independent life. The extremities remained without function and sensation. Urinary continence and sexual function were present and the colostomy could be relocated in both patients. Both patients support limb salvage, even having difficulties and follow-up treatments. Concomitant cases are required to consolidate the findings. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- J Herold
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Dresden, Germany.
| | - D Notov
- Department of Orthopedic, Trauma and Plastic Surgery, University Hospital of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - C Reeps
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Dresden, Germany
| | - K D Schaser
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Dresden, Germany
| | - K Kamin
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Dresden, Germany
| | - M Mäder
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Dresden, Germany
| | - C Kleber
- Department of Orthopedic, Trauma and Plastic Surgery, University Hospital of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
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3
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Li J, Shi JB, Hong P, Wang YS, Ze HR, Lee RJ, Tang X. Combined treatment with vacuum sealing drainage, TopClosure device, and Ilizarov technique for traumatic hemipelvectomy: A rare case report of successful repairing of large-size soft tissue defects. Medicine (Baltimore) 2019; 98:e14205. [PMID: 30681595 PMCID: PMC6358379 DOI: 10.1097/md.0000000000014205] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
RATIONALE Traumatic hemipelvectomy is a rare but lethal catastrophic injury. PATIENT CONCERNS A case of a very young child with open fracture of left sacroiliac joint dislocation and pubic symphysis diastasis, suffered from a severe large-size soft tissue defects. DIAGNOSIS Traumatic hemipelvectomy. INTERVENTIONS Complete amputation was performed and three kinds of surgical techniques including regulated negative pressure-assisted wound therapy (RNPT), TopClosure device, and Ilizarov technique were jointly utilized to secure closure in the further revisions of the soft tissue injury and reconstruct reconstructive surgery. OUTCOMES Six months after hospital discharge, the patient was able to ambulate with a single limb and a prosthesis and she is independent in many activities of daily living currently. LESSONS We report this case to share experience with other clinicians in the management of this deadly extensive defects after traumatic hemipelvectomy in patients.
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Affiliation(s)
- Jin Li
- Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Jie Bao Shi
- Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Pan Hong
- Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Yu Shang Wang
- Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Hao Ren Ze
- Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Rushyuan Jay Lee
- Department of Orthopaedic Surgery, Bloomberg Children's Hospital, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Xin Tang
- Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
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4
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Smith AC, Flinn DC, Jang Y, Faulkner AM, Dinnan KA. Traumatic Hemipelvectomy with a Contralateral Unstable Pelvis and Acetabular Fracture: A Case Report and Review of the Literature. JBJS Case Connect 2017; 7:e52. [PMID: 29252882 DOI: 10.2106/jbjs.cc.16.00211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
CASE A traumatic hemipelvectomy (THP) is a rare life-threatening injury, with limited reports in the civilian population. We present the case of a patient who sustained a massive pelvic injury with an incomplete unilateral THP, a contralateral unstable pelvis, and a fracture of the acetabulum. CONCLUSION With advancements in resuscitative techniques, carefully timed and planned surgical interventions, and a coordinated multidisciplinary approach, a greater number of patients may be able to survive a massive pelvic injury.
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Affiliation(s)
- Andrew C Smith
- Departments of Orthopaedic Surgery (A.C.S., D.C.F., Y.J., and A.M.F.), and Trauma Surgery and Critical Care (K.A.D.), Beaumont Health Farmington Hills, Farmington Hills, Michigan
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5
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Haim S, Laufer Y, Leonid K, Daniel G, Yechiel S, Zeev Z, Yury G, Asher KA, Michal EG. Hemipelvectomy after severe pelvic injury in Factor VII deficiency toddler. Injury 2014; 46:1178-82. [PMID: 25733368 DOI: 10.1016/j.injury.2014.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 10/30/2014] [Accepted: 11/17/2014] [Indexed: 02/02/2023]
Abstract
Traumatic hemipelvectomy is a lethal catastrophic injury. The reported average age of individuals surviving this trauma is 21 years old, suggesting the necessity of good physiological reserves to survive this type of injury. Dealing with this injury in children may call for special requirements throughout all the stages of diagnosis, treatment and rehabilitation. Experience in the resuscitation and subsequent treatment of individuals suffering from this traumatic condition in the paediatric population is even scarce. There are only several reported cases involving children and none of the paediatric cases suffered from comorbidities prior to their traumatic injury. The present report describes the successful management of a 16-month-old child with a medical history of a rare bleeding disorder a severe coagulation Factor VII deficiency who underwent right-sided traumatic hemipelvectomy.
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Affiliation(s)
- Shtarker Haim
- Pediatric Orthopaedics, Western Galilee Hospital, Nahariya, Israel; Faculty of Medicine in Galilee, Bar Ilan University, Safed, Israel.
| | - Yocheved Laufer
- Physical Therapy Department, Faculty of Social Welfare and Health Studies, University of Haifa, Haifa, Israel
| | - Kogan Leonid
- Department of Plastic Surgery, Western Galilee Hospital, Nahariya, Israel; Faculty of Medicine in Galilee, Bar Ilan University, Safed, Israel
| | - Glikman Daniel
- Infectious Diseases Unit, Western Galilee Hospital, Nahariya, Israel; Faculty of Medicine in Galilee, Bar Ilan University, Safed, Israel
| | - Sweed Yechiel
- Department of Pediatric Surgery, Western Galilee Hospital, Nahariya, Israel; Faculty of Medicine in Galilee, Bar Ilan University, Safed, Israel
| | - Zonis Zeev
- Pediatric Intensive Care Unit, Western Galilee Hospital, Nahariya, Israel; Faculty of Medicine in Galilee, Bar Ilan University, Safed, Israel
| | - Grozovsky Yury
- Vascular Surgery Unit, Western Galilee Hospital, Nahariya, Israel; Faculty of Medicine in Galilee, Bar Ilan University, Safed, Israel
| | - Kuperman Amir Asher
- Pediatric Hematology and Coagulation Service, Western Galilee Hospital, Nahariya, Israel; Faculty of Medicine in Galilee, Bar Ilan University, Safed, Israel
| | - Elboim-Gabyzon Michal
- Physical Therapy Department, Faculty of Social Welfare and Health Studies, University of Haifa, Haifa, Israel
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6
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Salamon T, Kassis S, Lerner A. Hemipelvectomy images of loss caused by war. BMJ Case Rep 2014; 2014:bcr-2014-204479. [PMID: 25008336 DOI: 10.1136/bcr-2014-204479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
As we treat our 230th patient from the Syrian conflict, the pathology we see is more debilitating and the humanitarian needs of the wounded have become even more obvious. This case presents some graphic images of the realities of war. Care in the most advanced units cannot restore broken limbs, let alone broken lives. We present a case of a young war-injured man, who suffered severe crush injury to the pelvis and lower limb, arriving at our medical facility after a delay of hours. The lower limb was shattered from the pelvis down (essentially a traumatic hemipelvectomy). His life had been saved in Syria by ligation of the femoral vessels in an unknown facility by an unknown medical team. On arrival in a centre in Israel for definitive care of an unsalvageable leg, formal hemipelvectomy was performed.
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Affiliation(s)
- Tal Salamon
- Department of Vascular Surgery, Ziv Medical Center, Safed, Israel Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | | | - Alexander Lerner
- Ziv Medical Center, Safed, Israel Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
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7
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Wu TH, Wu XR, Zhang X, Wu CS, Zhang YZ, Peng AQ. Management of traumatic hemipelvectomy: an institutional experience on four consecutive cases. Scand J Trauma Resusc Emerg Med 2013; 21:64. [PMID: 23953033 PMCID: PMC3765128 DOI: 10.1186/1757-7241-21-64] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 08/05/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND OBJECTIVE The incidence of traumatic hemipelvectomy is rare, but it is a devastating injury. Recently, an increasing number of patients with traumatic hemipelvectomy are admitted to trauma centers alive due to improvements of the pre-hospital care. Successful management requires prompt recognition of the nature of this injury and meticulous surgical technique. We present our successful experiences on four cases of traumatic hemipelvectomy in the past nine years. PATIENTS AND METHODS Four cases with traumatic hemipelvectomy were admited to our hospital from June 21, 2002 to September 3, 2011. All injuries occurred due to vehicle accident and all patients were in a state of severe hypotension, with two of them having anal lacerations. These four cases were treated immediately with resuscitation, control of hemorrhage, early amputation, repeated debridement and closure of the wounds. An angiographic embolization was given to control hemorrhage in two of the cases preoperatively. One case underwent fecal diversion. Wound infection occurred in all of cases which was successfully controlled by repeated debridements, effective anti-biotic regimen, split-thickness skin grafts. RESULTS All four cases were saved successfully with well-healed wounds during follow up from 1 to 7 years. They were able to walk by themself using crutches. CONCLUSION Adhering to the surgery principles of damage control including appropriate resuscitation, hemorrhage control, coagulopathy correction and multiple debridements and closure of the wounds in reasonable period of time can save the life of cases suffering from severe pelvic ring injury.
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Affiliation(s)
- Tian-hao Wu
- Emergercy Trauma Center, Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
| | - Xi-rui Wu
- Emergercy Trauma Center, Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
| | - Xiao Zhang
- Emergercy Trauma Center, Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
| | - Chun-sheng Wu
- Emergercy Trauma Center, Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
| | - Ying-ze Zhang
- Emergercy Trauma Center, Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
| | - A-qin Peng
- Emergercy Trauma Center, Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
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8
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Carr JS, Morse BC, Vercruysse GA, Wyrzykowski AD, Moore TJ, Feliciano DV. Traumatic Hemipelvectomy: A Survivor of a Catastrophic Injury. Am Surg 2012. [DOI: 10.1177/000313481207800610] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jacquelyn S. Carr
- Department of Surgery Emory University School of Medicine Grady Memorial Hospital Atlanta, Georgia
| | - Bryan C. Morse
- Department of Surgery Emory University School of Medicine Grady Memorial Hospital Atlanta, Georgia
| | - Gary A. Vercruysse
- Department of Surgery Emory University School of Medicine Grady Memorial Hospital Atlanta, Georgia
| | - Amy D. Wyrzykowski
- Department of Surgery Emory University School of Medicine Grady Memorial Hospital Atlanta, Georgia
| | - Thomas J. Moore
- Department of Orthopaedic Surgery Emory University School of Medicine Grady Memorial Hospital Atlanta, Georgia
| | - David V. Feliciano
- Department of Surgery Emory University School of Medicine Grady Memorial Hospital Atlanta, Georgia
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9
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Timmers TK, Tiren D, Hulstaert PF, Schellekens PPA, Leenen LPH. Traumatic hemipelvectomy: Improvements in the last decennia illustrated by 2 case reports. Int J Surg Case Rep 2012; 3:246-52. [PMID: 22504479 DOI: 10.1016/j.ijscr.2012.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2011] [Revised: 02/14/2012] [Accepted: 03/09/2012] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION In this article we present two cases of young men who sustained a traumatic hemipelvectomy. PRESENTATION OF CASE The first case occurred more than 10 years ago and the second case happened less than 1 year ago. Changes in the management for resuscitation, surgical intervention, and in postoperative treatment are detailed. Goal of this article is to evaluate the changes over time in the treatment of trauma in general and this specific injury in particular. DISCUSSION Maximum survival chance could be achieved by an aggressive resuscitation (following a massive transfusion protocol-ratio of 1:1:1 unit of blood-products), starting pre-hospitally and continued in the emergency department, immediate control of the haemorrhage and direct surgical intervention. Early and frequent re-explorations are necessary to prevent complications as sepsis and to minimize the chance for complications such as disturbed wound healing and fistula formation. The use of the Vacuum-Assisted Closure therapy nowadays gives the patient an earlier recover and lesser chance at developing complications. Early consultation with plastic surgeons needs to be done in order to achieve an adequate definitive wound-closure (reconstructive surgery). CONCLUSION A traumatic hemipelvectomy is a catastrophic and mutilating injury, seldom survivable. Maximum survival chance could be achieved by an aggressive resuscitation, frequent re-explorations, the use of VAC therapy and early consultation with a plastic surgeon for reconstructive surgery.
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Affiliation(s)
- T K Timmers
- University Medical Centre Utrecht, Department of Surgery, P.O.-box 85500, 3508 GA Utrecht, The Netherlands
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10
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Lasurt S, Combalia-Aleu A. Complete traumatic hemipelvectomy: Report of a case after 19 years of follow-up. Injury 2010; 41:874-82. [PMID: 20478558 DOI: 10.1016/j.injury.2010.04.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Accepted: 04/07/2010] [Indexed: 02/02/2023]
Affiliation(s)
- Sandra Lasurt
- Hospital Clínic, University of Barcelona, Department of Orthopaedic Surgery and Trauma, Barcelona, Spain
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11
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Whitney K, Haynes L, Smith DC. Train versus pedestrian resulting in traumatic hemipelvectomy. J Emerg Nurs 2010; 36:284-6. [PMID: 20457334 DOI: 10.1016/j.jen.2010.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Kathleen Whitney
- Emergency Department, Texas Health Harris Fort Worth Hospital, Fort Worth, TX, USA.
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12
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Affiliation(s)
- Pedro C Cavadas
- Division of Reconstructive Surgery, Centro de Rehabilitación de Levante, Valencia, Spain.
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13
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Osti M, Mittler C, Putzke M, Benedetto KP. Traumatic hemipelvectomy: a report of successful reimplantation. Injury 2006; 37:1015-8. [PMID: 16934812 DOI: 10.1016/j.injury.2006.06.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2006] [Accepted: 06/21/2006] [Indexed: 02/02/2023]
Affiliation(s)
- Michael Osti
- Departments of Trauma Surgery and Sports Traumatology, Academic Hospital Feldkirch, 6800 Feldkirch, Austria.
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14
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Abstract
With an incidence of only 0.6% of all pelvic injuries, traumatic hemipelvectomy is a rare event. It is defined as open or closed avulsion of one hemipelvis with occlusion or disruption of the main vessels and lengthening or disruption of the nerves, often complicated by urogenital or anorectal injuries. The mechanism of injury in this case is a typical one with extreme abduction and external rotation of the leg, causing sacroiliac joint disruption and symphysis separation. Two other mechanisms described are avulsion when the leg becomes entangled in a piece of machinery or a massive crushing at the groin. After a fast treatment in the field, the patient described was treated with immediate open revision, tamponade and stabilization of the pelvis. Upper leg preservation by reconstruction of the femoral vessels with vascular prostheses was attempted. Because of a broad necrosis of soft tissues, early completion of the hemipelvectomy was performed. The patient recovered well. Miction and bowel evacuation as well as sexual function could be preserved. The resulting quality of life is high and the patient is socially reintegrated without problems.
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Affiliation(s)
- J Heineck
- Klinik für Unfall- und Wiederherstellungschirurgie, Universitätsklinik Dresden, Fetscherstr. 74, 01307 Dresden.
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15
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Schoderbek RJ, Battaglia TC, Dorf ER, Kahler DM. Traumatic hemipelvectomy: case report and literature review. Arch Orthop Trauma Surg 2005; 125:358-62. [PMID: 15843944 DOI: 10.1007/s00402-005-0814-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2004] [Indexed: 02/09/2023]
Abstract
Traumatic hemipelvectomy is a rare but devastating injury involving complete disruption of the hemipelvis from the pubic symphysis to the sacroiliac joints and often results in death. We present an interesting case of traumatic hemipelvectomy caused by a previously undescribed mechanism of injury in which judicious angiography and aggressive surgical treatment contributed to patient survival.
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Affiliation(s)
- Robert J Schoderbek
- Department of Orthopaedic Surgery, University of Virginia Health Sciences Center, Box 800159, Charlottesville, VA, 22908, USA
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