Traumatic hemipelvectomy: case report and literature review

Abstract

Traumatic hemipelvectomy is a rare but devastating injury involving complete disruption of the hemipelvis from the pubic symphysis to the sacroiliac joints and often results in death. We present an interesting case of traumatic hemipelvectomy caused by a previously undescribed mechanism of injury in which judicious angiography and aggressive surgical treatment contributed to patient survival.

Late presentation with whole limb gangrene following open traumatic hemipelvectomy

“…This leaves the limb functionally and anatomically useless. Despite this, it has been reported that in more than 50% of cases, the limb is still attached to the patient by a bridge of skin following this injury [2,13]. This was demonstrated in this case.…”

“…This is particularly true in the rural areas which are also devoid of health care facilities equipped to handle adequate resuscitation of victims of major trauma. More often than not, advanced resuscitation techniques including arterial embolization and emergency operative exploration are necessary to achieve haemostasis [2]. Our patient sustained this injury in a rural environment and received initial management at a primary health care facility where she received sub-optimal care by the standards of her injuries.…”

“…In particular, side swipe injuries involving motor or pedal cyclist have been reported in the literature as the commonest mechanism, accounting for about 40% of all cases of traumatic hemipelvectomy [2,8,9]. They cause disruption to the symphysis pubis and sacroiliac joints, which is the usual plane of separation in as many as 71% of cases [4].…”

“…It is characterized by a very high mortality rate, with death usually resulting from rapid exsanguination [1,2]. There are an increasing number of reports in the literature of patients, who have survived this injury.…”

Traumatic Hemipelvectomy

“…The survivors, almost < 30 years, were healthy individuals able to tolerate massive hemorrhage and soft-tissue destruction [16,22,23]. Patients with complete hemipelvectomy seem to have a better chance of survival than patients with partial hemipelvectomy.…”