An unusual case of transpelvic impalement injury: A case-report

Impalement injury is a rare type of mechanical injury following forceful insertion of projecting object into the body. Careful planning for removal of the impaling object is essential to decrease the blood loss and preserve the function of the injured organ.

A 27 year-old male fell from 4m height over a U shaped projecting up metallic bar. The bar penetrated the left side of the pelvis and traversed through the left iliac bone causing a comminuted fracture in the supra-acetabular region extending to the left psoas muscle, injuring the viscera and causing fracture of the right femur. Exploratory laparotomy was performed and the metallic bar was pulled out from the sigmoid colon through the inlet of the injury. Intramedullary nailing was performed for femur fracture. The patient developed infection (Methicillin-sensitive Staphylococcus aureus and Escherichia coli) during the post-operative course that was successfully managed with antibiotic therapy. Finally the patient was sent home after a week in a good health condition.

Two surgical teams worked in sequence to fix the injuries starting with the trauma team followed by the orthopedic surgeons.

Impalement injury is a serious injury that needs a multidisciplinary team with a coordinated approach to achieve a favorable outcome.