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Published on: January 25, 2010
Traumatic hemipelvectomy: an appeal for primary completion
Jan Lindahl1,2, Minna Laitinen3,4, Axel Gänsslen5
1Department of Orthopaedics and Traumatology, Helsinki University Hospital, Helsinki, Finland. jan.lindahl@hus.fi.
Insights
Traumatic hemipelvectomy (TH) is a severe pelvic injury requiring immediate, aggressive damage-control resuscitation. Primary completion of TH is recommended over limb salvage in critical ischemia or sacral plexus injury cases.
Area of Science:
- Trauma Surgery
- Orthopedic Surgery
- Emergency Medicine
Background:
- Traumatic hemipelvectomy (TH) represents a rare, life-threatening pelvic injury with high mortality.
- Management challenges include severe pelvic fractures, associated injuries, and potential exsanguination.
- Existing literature primarily focuses on survivors, lacking comprehensive treatment guidelines.
Purpose of the Study:
- To outline aggressive, standardized damage-control strategies for managing traumatic hemipelvectomy.
- To provide recommendations for surgical management, including limb salvage versus completion of hemipelvectomy.
- To address critical aspects of resuscitation, vascular repair, and soft-tissue management.
Main Methods:
- Review of current literature and case series on traumatic hemipelvectomy.
- Emphasis on standardized damage-control procedures in prehospital, emergency room, and initial surgical phases.
- Discussion of massive transfusion protocols, vascular injury management, and colostomy considerations.
Main Results:
- Aggressive initial treatment is crucial to prevent exsanguination and contamination.
- Massive transfusion protocols are vital for managing traumatic coagulopathy.
- Primary completion of hemipelvectomy is often favored over limb salvage due to lower complication rates and better functional outcomes in specific cases (critical ischemia, sacral plexus injury).
Conclusions:
- Standardized damage-control resuscitation is paramount for patients with traumatic hemipelvectomy.
- Early surgical intervention should focus on preventing exsanguination and contamination.
- Completion of hemipelvectomy is recommended in cases of critical ischemia and significant sacral plexus injury to improve outcomes.
Abstract:
Traumatic hemipelvectomy (TH) is a rare and extremely severe injury of the pelvic area, which is often life-threatening and associated with a high mortality rate. Individual treatment is focused on the pelvic fracture and the type of accompanying injuries. The management of these severely injured patients places a considerable challenge on the resuscitation team. Patient management should be aggressive from the start. Current literature is focused predominantly on survivors, with only few case series providing possible treatment recommendations. Aggressive initial treatment is focused on standardized damage-control procedures during the prehospital, emergency room, and initial surgical phase to prevent exsanguination and contamination; a massive transfusion protocol should also be initiated immediately to address traumatic coagulopathy. Standard vascular treatment addresses the vascular injury. Colostomy is often recommended for adequate soft-tissue trauma management. Attempts at limb salvage often result in higher complications rates with non-functional limbs compared with completion of the TH. Thus, in cases of critical ischemia and identified relevant sacral nervous plexus injury during initial debridement in predominantly open injuries, primary completion of the hemipelvectomy is recommended. Level of Evidence: IV.
