Simultaneous anterior and posterior traumatic dislocations of both hips are very rare. Only 33 cases have been previously reported in the English language literature. Although they were all due to high-energy injuries...Simultaneous anterior and posterior traumatic dislocations of both hips are very rare. Only 33 cases have been previously reported in the English language literature. Although they were all due to high-energy injuries, they were hemodynamically stable and had a stable pelvic ring. We report a unique case of asymmetrical hip dislocations with an unstable pelvic ring and hemodynamic instability. A 40-year-old man was injured in a high-energy motor vehicle accident. He was hemodynamically unstable when he presented in the emergency department. Radiolographs showed asymmetrical dislocations of both hips with an unstable pelvic ring. Under general anesthesia, he had closed reduction of the dislocations of both hips, followed by temporary stabilization with an external fixator. Transcatheter arterial embolization was performed to stop active pelvic bleeding. Delayed open reduction and internal fixation was performed 12 d later with anterior and posterior plates. The patient recovered well with an uneventful post-operative course. Asymmetrical bilateral hip dislocations with pelvic ring instability caused by trauma, as presented in this case, is very rare and potentially life threatening. Prompt treatment can give a good outcome.展开更多
AIM: To determine the association of unstable pelvic ring injuries with trauma code status.METHODS: A retrospective review of all pelvic ring injuries at a single academic center from July 2010 to June 2013 was perfor...AIM: To determine the association of unstable pelvic ring injuries with trauma code status.METHODS: A retrospective review of all pelvic ring injuries at a single academic center from July 2010 to June 2013 was performed. The trauma registry was used to identify level 1 and level 2 trauma codes for each injury. The computed tomography scans in all patients were classified as stable or unstable using the Abbreviated Injury Scale. Pelvic injury classifications in level 1 and level 2 groups were compared. Patient disposition at discharge in level 1 and level 2 groups were also compared.RESULTS: There were 108 level 1 and 130 level 2 blunt trauma admissions. In the level 1 group, 67% of pelvic injuries were classified as stable fracture patterns and 33% were classified as unstable. In the level 2 group, 62% of pelvic injuries were classified as stable fracture patterns and 38% were classified as unstable. level 1 trauma code was not associated with odds of having an unstable fracture pattern(OR = 0.83, 95%CI: 0.48-1.41, P = 0.485). In the level 1 group with unstable pelvic injuries, 33% were discharged to home, 36% to a rehabilitation facility, and 32% died. In the level 2 group with unstable pelvic injuries, 65% were discharged to home, 31% to a rehabilitation facility, and 4% died. For those with unstable pelvic fractures(n = 85), assignment of a level 2 trauma code was associated with reduced odds of death(OR = 0.07, 95%CI: 0.01-0.35, P = 0.001) as compared to being discharged to home.CONCLUSION: Trauma code level assignment is not correlated with severity of pelvic injury. Because an unstable pelvis can lead to hemodynamic instability, these injuries may be undertriaged.展开更多
Traumatic diaphragmatic hernia （TDH） is an uncommon injury and a marker of severe trauma.This injury is rarely associated with pelvic ring fracture,although TDH is one of the most dangerous comorbidities of such fra...Traumatic diaphragmatic hernia （TDH） is an uncommon injury and a marker of severe trauma.This injury is rarely associated with pelvic ring fracture,although TDH is one of the most dangerous comorbidities of such fractures.Since this condition is easily misdiagnosed in emergency cases,we reported two cases and analyzed the clinical symptoms,diagnosis,treatment,and outcome of this comorbidity.Based on these results,we recommended an appropriate method for diagnosis and treatment and proposed a contraindication in treating TDH associated with pelvic fracture.展开更多
Background: To provide patients with a superior quality of life (QOL) after their pelvic tumor resection, ensuring the stability of the trunk as well as satisfactory lower extremity function is important. Although mic...Background: To provide patients with a superior quality of life (QOL) after their pelvic tumor resection, ensuring the stability of the trunk as well as satisfactory lower extremity function is important. Although microsurgical reconstructions for the pelvic ring and hip are used clinically, the details of postoperative long-term spinal deformity and QOL remain unclear. Methods: The patients were 66- and 43-year-old men and a 43-year-old woman. The mean postoperative follow-up period was 134 months. The surgical procedures performed on these patients were: pelvic ring reconstruction using a double-barreled free vascularized fibular graft (FVFG) in Patient 1;simultaneous pelvic ring reconstruction using FVFG and hip arthrodesis in Patient 2;and latissimus dorsi free flap without pelvic ring reconstruction in Patient 3. As indicators of spinal deformity, we measured the Cobb angle, thoracic kyphosis angle, lumbar lordosis angle, pelvic angle on the sagittal plane, and sagittal plane balance using whole spine radiography. To assess the patients’ QOL, we examined the International Society of Limb Salvage (ISOLS) score, the Roland-Morris Disability Questionnaire (RDQ), activities of daily living (ADL) satisfaction using a visual analogue scale (VAS), and the SF-36. Results: Spinal alignment in the frontal plane worsened in order from Patient 1 to 3. Spinal alignment and pelvic tilt in the sagittal plane were at appropriate levels in Patients 1 and 2. The trunk tilt in the sagittal plane was at an appropriate level only in Patient 1. In the QOL assessment, the function of the affected limb worsened in order from Patient 1 to 3. RDQ scores were lower than the national norm in Patients 2 and 3. With respect to ADL satisfaction and the SF-36, Patient 3 had a markedly low VAS, physical functioning, role-physical, and role-emotional scores. Conclusion: In the long-term clinical course after pelvic tumor resection, in order to obtain satisfactory spinal alignment and QOL, pelvic ring reconstruction and hip arthrodesis are important.展开更多
基金Zhejiang Scientific and Technological Plan of Traditional Chinese Medicine,No.2018ZB033Zhejiang Medical and Health Science and Technology Project,No.2018234792
文摘Simultaneous anterior and posterior traumatic dislocations of both hips are very rare. Only 33 cases have been previously reported in the English language literature. Although they were all due to high-energy injuries, they were hemodynamically stable and had a stable pelvic ring. We report a unique case of asymmetrical hip dislocations with an unstable pelvic ring and hemodynamic instability. A 40-year-old man was injured in a high-energy motor vehicle accident. He was hemodynamically unstable when he presented in the emergency department. Radiolographs showed asymmetrical dislocations of both hips with an unstable pelvic ring. Under general anesthesia, he had closed reduction of the dislocations of both hips, followed by temporary stabilization with an external fixator. Transcatheter arterial embolization was performed to stop active pelvic bleeding. Delayed open reduction and internal fixation was performed 12 d later with anterior and posterior plates. The patient recovered well with an uneventful post-operative course. Asymmetrical bilateral hip dislocations with pelvic ring instability caused by trauma, as presented in this case, is very rare and potentially life threatening. Prompt treatment can give a good outcome.
文摘AIM: To determine the association of unstable pelvic ring injuries with trauma code status.METHODS: A retrospective review of all pelvic ring injuries at a single academic center from July 2010 to June 2013 was performed. The trauma registry was used to identify level 1 and level 2 trauma codes for each injury. The computed tomography scans in all patients were classified as stable or unstable using the Abbreviated Injury Scale. Pelvic injury classifications in level 1 and level 2 groups were compared. Patient disposition at discharge in level 1 and level 2 groups were also compared.RESULTS: There were 108 level 1 and 130 level 2 blunt trauma admissions. In the level 1 group, 67% of pelvic injuries were classified as stable fracture patterns and 33% were classified as unstable. In the level 2 group, 62% of pelvic injuries were classified as stable fracture patterns and 38% were classified as unstable. level 1 trauma code was not associated with odds of having an unstable fracture pattern(OR = 0.83, 95%CI: 0.48-1.41, P = 0.485). In the level 1 group with unstable pelvic injuries, 33% were discharged to home, 36% to a rehabilitation facility, and 32% died. In the level 2 group with unstable pelvic injuries, 65% were discharged to home, 31% to a rehabilitation facility, and 4% died. For those with unstable pelvic fractures(n = 85), assignment of a level 2 trauma code was associated with reduced odds of death(OR = 0.07, 95%CI: 0.01-0.35, P = 0.001) as compared to being discharged to home.CONCLUSION: Trauma code level assignment is not correlated with severity of pelvic injury. Because an unstable pelvis can lead to hemodynamic instability, these injuries may be undertriaged.
文摘Traumatic diaphragmatic hernia （TDH） is an uncommon injury and a marker of severe trauma.This injury is rarely associated with pelvic ring fracture,although TDH is one of the most dangerous comorbidities of such fractures.Since this condition is easily misdiagnosed in emergency cases,we reported two cases and analyzed the clinical symptoms,diagnosis,treatment,and outcome of this comorbidity.Based on these results,we recommended an appropriate method for diagnosis and treatment and proposed a contraindication in treating TDH associated with pelvic fracture.
文摘Background: To provide patients with a superior quality of life (QOL) after their pelvic tumor resection, ensuring the stability of the trunk as well as satisfactory lower extremity function is important. Although microsurgical reconstructions for the pelvic ring and hip are used clinically, the details of postoperative long-term spinal deformity and QOL remain unclear. Methods: The patients were 66- and 43-year-old men and a 43-year-old woman. The mean postoperative follow-up period was 134 months. The surgical procedures performed on these patients were: pelvic ring reconstruction using a double-barreled free vascularized fibular graft (FVFG) in Patient 1;simultaneous pelvic ring reconstruction using FVFG and hip arthrodesis in Patient 2;and latissimus dorsi free flap without pelvic ring reconstruction in Patient 3. As indicators of spinal deformity, we measured the Cobb angle, thoracic kyphosis angle, lumbar lordosis angle, pelvic angle on the sagittal plane, and sagittal plane balance using whole spine radiography. To assess the patients’ QOL, we examined the International Society of Limb Salvage (ISOLS) score, the Roland-Morris Disability Questionnaire (RDQ), activities of daily living (ADL) satisfaction using a visual analogue scale (VAS), and the SF-36. Results: Spinal alignment in the frontal plane worsened in order from Patient 1 to 3. Spinal alignment and pelvic tilt in the sagittal plane were at appropriate levels in Patients 1 and 2. The trunk tilt in the sagittal plane was at an appropriate level only in Patient 1. In the QOL assessment, the function of the affected limb worsened in order from Patient 1 to 3. RDQ scores were lower than the national norm in Patients 2 and 3. With respect to ADL satisfaction and the SF-36, Patient 3 had a markedly low VAS, physical functioning, role-physical, and role-emotional scores. Conclusion: In the long-term clinical course after pelvic tumor resection, in order to obtain satisfactory spinal alignment and QOL, pelvic ring reconstruction and hip arthrodesis are important.
