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 that was knocked down by a four-wheeler near Krishnagiri in Tamil Nadu. He was immediately rushed to the Government Hospital at Krishnagiri, where initial haemodynamic stabilization was done, and was then 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 continued to be haemodynamically unstable, and his haemoglobin hovered around 5.5 g% despite repeated blood transfusions. At this stage, he was transferred to our hospital for angio-embolization of the pelvic vessels.
A CT angiogram was done here, which did not show any active bleeder. However, there was a large retro-vesical haematoma 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 and was also put on mechanical DVT prophylaxis (Flowtron pump). On the 4th day after admission, the CT scan was repeated. It did not show any increase in the size of the retro-vesical haematoma, and he was taken up for surgery on the same day. Open reduction of the symphyseal diastasis was done using a Pfannenstiel approach, with stabilization achieved using a 4-hole plate. Open reduction and anterior double plating of the right sacroiliac joint was done. In the same sitting, ORIF of the fractured femoral shaft was done using a locked intramedullary nail.
He was in the ICU for a day and shifted back to the ward after that. Immediate wheelchair ambulation was started on the first post-operative day, along with knee bending and active quadriceps exercises. He was very comfortable with wheelchair–bed transfers and the mobilization exercises, and was discharged in a stable condition 5 days after surgery. At 6 weeks post-op, he had started walking with the help of a walker frame.
We were a comprehensive trauma team at BGS Global Hospital, Bangalore, with the solid backing of 24/7 emergency care and blood bank, plastic surgeon, interventional radiologist, abdominal surgeon, neurosurgeon and physiotherapists. Not only patients but also other major hospitals in Bangalore recognised this wholesome approach to the care of polytraumatised patients. This 18-year-old stands testimony to the trust patients and other major hospitals placed in us.
References
- Goldstein A, Phillips T, Sclafani SJ, Scalea T, Duncan A, Goldstein J, et al. Early open reduction and internal fixation of the disrupted pelvic ring. J Trauma. 1986;26(4):325–33.
- Barei DP, Shafer BL, Beingessner DM, Gardner MJ, Nork SE, Routt ML. The impact of open reduction internal fixation on acute pain management in unstable pelvic ring injuries. J Trauma. 2010;68(4):949–53.
- 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.
- Matta JM, Tornetta P III. Internal fixation of unstable pelvic ring injuries. Clin Orthop Relat Res. 1996;329:129–140.