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Early Stabilization & Mobilization in unstable Pelvic Injuries

An 18 year old boy met with an unfortunate accident on the road. He was pillion-riding on a bike which was knocked down by a 4-wheeler near krishnagiri in Tamilnadu. He was immediately rushed to the Govt. Hospital at krishnagiri,initial hemodynamic stabilization was done and was shifted to a major hospital in Bangalore. On evaluation,he was found to have an unstable fracture of the pelvic ring and a closed fracture of the shaft of his right femur. He however.continued to be hemodynamicallly unstable and his Hemoglobin was hovering around 5.5g% inspite of repeated blood transfusions.at this stage,he was transfered to our hospital for angio-embolization of pelvic vessels.At CT angiogram was done here, which did not show any active bleeder. However,there was a large retro-vesical hematoma collection displacing the urinary bladder.The interventional Radiologist opined that angio-embolization was not necessary.

He stabilized over the next 3 days with blood transfusion.he was also put on mechanical DVT prophyaxis(Flowtron Pump). On the 4th day after admission here, CT scan was repeated. It did not show any increase in the size of the retro-vesical hematoma. He was taken up for surgery on the same day. open reduction of the symphysical diastasis was done using a Pfannensteil approach and stabilization achieved with a 4 hole plate. Open reduction and anterior double plating of right Sacroiliac joint was done. In the same sitting ORIF of fracture shaft femur was done using a locked intramedullary naill. He was in the ICU for a day,was shifted back to the ward after that.Immediate wheel chair ambulation was started on the first post-op day,along with knee bending and active quadriceps excercises.he was very comfortable with the wheelchair - bed transfer and with the mobilization excerses. He was discharged in a stable condition, 5 days after the surgery.At 6 weeks post-op, he has started walking with the help of a walker frame.

We are a comprehensive trauma team at BGS Global Hospital, Bangalore, with a solid backing of a 24/7 Emergency care & Blood bank ,Plastic Surgeon, Interventional Radiologist, Abdominal Surgeon, Neurosurgeon and Physiotherapists. Not only patients but also other major hospitals in Bangalore recognize our wholesome approach to the care of polytraumatised patients. This 18 year old stands a testimony to the trust patients and other major hospitals have placed in us.

References:

1.Goldstein A, Phillips T, Sclafani SJ, Scalea T, Duncan A, Goldstein j, et al.Early open reduction and interval fixation of the distrupted pelvic ring.J Trauma. 1986;26(4):325-33.

2.Barei DP, Shafer BL, Beingessner DM, Gardner MJ, Nork SE, Routt ML. The impact of open reduction interval fixation on acute pain management in unstable pelvic ring injuries. J Trauma.2010;68(4):949-53.

3.Latenser BA, Gentilello LM,Tarver AA, Thalgott JS, Batdorf JW. Improved Outcome with Early Fixation of Skeletally Unstable pelvic Fractures.J Trauma. 1991;31(1):28-31.

4.Matta JM;Tornetta P lll.Interval Fixation of Unstable Pelvic Ring Injuries.Clin Orth Rel Res 1996;329:129-140.

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