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Management of partial traumatic hemipelvectomy.

Guodong Wang, Dongsheng Zhou, Wun-Jer Shen

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    |November 9, 2013
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    Summary

    Partial traumatic hemipelvectomy presents a high mortality risk. Early completion of hindquarter amputation after hemorrhage control is recommended for better outcomes in these severe pelvic fracture cases.

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    Area of Science:

    • Trauma Surgery
    • Orthopedic Surgery
    • Emergency Medicine

    Background:

    • Partial traumatic hemipelvectomy, despite limb retention, has a higher mortality than complete hemipelvectomy.
    • This condition is associated with severe pelvic fractures, multiple injuries, and profound hypovolemic shock.

    Observation:

    • Seven patients with partial traumatic hemipelvectomy experienced massive hemorrhage, requiring immediate control via balloon occlusion, laparotomy, and external fixation.
    • Initial resuscitation efforts were critical, with two patients dying early.
    • Limb preservation attempts failed, necessitating hindquarter amputation. Angiography provided no treatment-altering information.

    Findings:

    • Early completion of hindquarter amputation (within 24 hours) yielded the best results among survivors.
    • All surviving patients experienced significant disability, becoming wheelchair-dependent and unable to return to work.

    Implications:

    • Prompt surgical intervention, specifically early hindquarter amputation, is crucial for managing life-threatening hemorrhage in partial traumatic hemipelvectomy.
    • Current diagnostic tools like angiography may not be beneficial in the acute management decision-making process for these patients.