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[Traumatic hemipelvectomy. Experiences with 11 cases]

T Pohlemann1, C Paul, A Gänsslen

  • 1Unfallchirurgische Klinik, Medizinische Hochschule Hannover.

Der Unfallchirurg
|April 1, 1996
PubMed
Summary
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Traumatic hemipelvectomy is a severe injury requiring immediate surgical completion for survival. Limb-saving procedures are associated with higher mortality, emphasizing the need for a strict treatment protocol.

Area of Science:

  • Trauma Surgery
  • Orthopedic Surgery
  • Emergency Medicine

Background:

  • Increasing survival rates for severe injuries like traumatic hemipelvectomy necessitate optimized treatment strategies.
  • Traumatic hemipelvectomy is defined as an unstable hemipelvic injury with neurovascular compromise.

Purpose of the Study:

  • To analyze the early clinical course of patients with traumatic hemipelvectomy.
  • To evaluate the long-term outcomes for survivors of traumatic hemipelvectomy.

Main Methods:

  • Retrospective review of clinical and radiological data for preclinical and primary treatment.
  • Analysis of concomitant injuries, causes of death, and complications.
  • Long-term follow-up of survivors, averaging 5.5 years post-trauma.

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Main Results:

  • Four patients died within 4 hours from uncontrollable bleeding despite aggressive prehospital and in-hospital management.
  • Three additional patients died from septic or hemorrhagic shock complications.
  • Primary surgical completion of hemipelvectomy resulted in a 75% survival rate, with good to moderate long-term outcomes in survivors.

Conclusions:

  • A strict protocol for traumatic hemipelvectomy is crucial, including immediate prehospital hemostasis, advanced shock therapy, and prompt trauma center transfer.
  • Surgical completion of hemipelvectomy is mandatory; limb-saving procedures increase mortality risk.
  • Early surgical hemostasis, debridement, frequent second-look operations, and psychological support are vital for patient outcomes.