Focus on pelvic trauma

Pelvic injuries account for 16 to 25% of all skeletal trauma in small pets. Small dogs as companion dogs are now widespread. Unusual exterior and behavioral features have made them popular and at the same time vulnerable in the modern urban environment. The author defined the nature of injuries and adapted technique of transosseous osteosynthesis for the treatment of toy-breed dogs with pelvic trauma. The study of the X-rays in 226 dogs with pelvic injuries demonstrated that toy-breed dogs accounted for 16% of the total. Multiple pelvic trauma was revealed in 95% of them. Surgical treatment was performed in 24 dogs, conservative one - in 13, that amounted to 65% and 35%, respectively. Surgical treatment consisted in open juxtaposing of fragments and focal transosseous and/or internal osteosynthesis with subsequent external fixation using devices of various designs. The external structures were of three types: half-ring support or U-shaped staple, pair of parallel curved plates connected by two threaded rods with each other, and pair of curved plates located bilaterally on both sides of the pelvis and connected by two threaded rods with the help of threaded ends. The terms of fixation for pelvic injuries in toy-breed dogs at the age under one year were 42 days on the average, and in the dogs at the age above one year - 60 days. Surgical treatment in toy-breed dogs with pelvic injuries was performed more often in comparison with conservative one. Pelvic trauma was accompanied by pronounced pain shock. The osteosynthesis techniques used in toy-breed dogs are little traumatic and not limiting functions thereby contributing to recovery of all the structures of pelvis and pelvic limbs.

Download Full-text

Accuracy of Contrast Extravasation on Computed Tomography for Diagnosing Severe Pelvic Hemorrhage in Pelvic Trauma Patients: A Meta-Analysis

Medicina ◽

10.3390/medicina57010063 ◽

2021 ◽

Vol 57 (1) ◽

pp. 63

Author(s):

Sung Nam Moon ◽

Jung-Soo Pyo ◽

Wu Seong Kang

Keyword(s):

Computed Tomography ◽

Meta Analysis ◽

Characteristic Curve ◽

Pelvic Trauma ◽

Test Accuracy ◽

Trauma Patients ◽

Positive Finding ◽

Summary Receiver Operating Characteristic ◽

Contrast Extravasation ◽

Pelvic Hemorrhage

Background and objective: The early detection of underlying hemorrhage of pelvic trauma has been a critical issue. The aim of this study was to systematically determine the diagnostic accuracy of computed tomography (CT) for detecting severe pelvic hemorrhage. Materials and Methods: Relevant articles were obtained by searching PubMed, EMBASE, and Cochrane databases through 28 November 2020. Diagnostic test accuracy results were reviewed to obtain the sensitivity, specificity, diagnostic odds ratio, and summary receiver operating characteristic curve of CT for the diagnosis in pelvic trauma patients. The positive finding on CT was defined as the contrast extravasation. As the reference standard, severe pelvic hemorrhage was defined as an identification of bleeding at angiography or by direct inspection using laparotomy that required hemostasis by angioembolization or surgery. A subgroup analysis was performed according to the CT modality that is divided by the number of detector rows. Result: Thirteen eligible studies (29 subsets) were included in the present meta-analysis. Pooled sensitivity of CT was 0.786 [95% confidence interval (CI), 0.574–0.909], and pooled specificity was 0.944 (95% CI, 0.900–0.970). Pooled sensitivity of the 1–4 detector row group and 16–64 detector row group was 0.487 (95% CI, 0.215–0.767) and 0.915 (95% CI, 0.848–0.953), respectively. Pooled specificity of the 1–4 and 16–64 detector row groups was 0.956 (95% CI, 0.876–0.985) and 0.906 (95% CI, 0.828–0.951), respectively. Conclusion: Multi-detector CT with 16 or more detector rows has acceptable high sensitivity and specificity. Extravasation on CT indicates severe hemorrhage in patients with pelvic trauma.

Download Full-text

Use of Pulsed-Field Gel Electrophoresis to Determine the Source of Methicillin-Resistant Staphylococcus aureus Bacteremia

Infectious Disease Reports ◽

10.3390/idr13030056 ◽

2021 ◽

Vol 13 (3) ◽

pp. 602-610

Author(s):

Eugene Y. H. Yeung ◽

Ivan Gorn

Keyword(s):

Staphylococcus Aureus ◽

Gel Electrophoresis ◽

Methicillin Resistant Staphylococcus Aureus ◽

Epidemiological Studies ◽

Pelvic Trauma ◽

Pulsed Field Gel Electrophoresis ◽

Bacterial Strains ◽

Methicillin Resistant ◽

Pulsed Field ◽

Clinical Cases

Pulsed-field gel electrophoresis (PFGE) has historically been considered the gold standard in fingerprinting bacterial strains in epidemiological studies and outbreak investigations; little is known regarding its use in individual clinical cases. The current study detailed two clinical cases in which PFGE helped to determine the source of their methicillin-resistant Staphylococcus aureus (MRSA) bacteremia. Patient A was found to have MRSA bacteremia after trauma in her pelvic area. MRSA was also found in her groin but not in her nostril and rectum. PFGE was performed that showed variable bands of her MRSA isolates from blood and groin, suggestive of different strains of MRSA. Her MRSA bacteremia was determined to be unrelated to her pelvic trauma. Patient B was found to have MRSA bacteremia after colonoscopy. MRSA was also found in his nostril and rectum. PFGE was performed that showed variable bands of his MRSA isolates from blood and rectum but identical bands of MRSA isolates from his blood and nostril. His MRSA bacteremia was determined to be unrelated to his colonoscopy procedure. The current study demonstrates the use of PFGE to rule out the source of bacteremia in individual clinical cases.

Download Full-text

Application of Pelvic Circumferential Compression Devices in Pelvic Ring Fractures—Are Guidelines Followed in Daily Practice?

Journal of Clinical Medicine ◽

10.3390/jcm10061297 ◽

2021 ◽

Vol 10 (6) ◽

pp. 1297

Author(s):

Valerie Kuner ◽

Nicole van Veelen ◽

Stephanie Studer ◽

Bryan Van de Wall ◽

Jürgen Fornaro ◽

...

Keyword(s):

Clinical Education ◽

Trauma Center ◽

Pelvic Ring ◽

Daily Practice ◽

Pelvic Trauma ◽

Fracture Pattern ◽

Pelvic Fractures ◽

Unstable Fracture ◽

Associated Injuries ◽

Resuscitation Room

Early administration of a pelvic circumferential compression device (PCCD) is recommended for suspected pelvic trauma. This study was conducted to evaluate the prevalence of PCCD in patients with pelvic fractures assigned to the resuscitation room (RR) of a Level I trauma center. Furthermore, correct application of the PCCD as well as associated injuries with potential clinical sequelae were assessed. All patients with pelvic fractures assigned to the RR of a level one trauma center between 2016 and 2017 were evaluated retrospectively. Presence and position of the PCCD on the initial trauma scan were assessed and rated. Associated injuries with potential adverse effects on clinical outcome were analysed. Seventy-seven patients were included, of which 26 (34%) had a PCCD in place. Eighteen (23%) patients had an unstable fracture pattern of whom ten (56%) had received a PCCD. The PCCD was correctly placed in four (15%) cases, acceptable in 12 (46%) and incorrectly in ten (39%). Of all patients with pelvic fractures (n = 77, 100%) treated in the RR, only one third (n = 26, 34%) had a PCCD. In addition, 39% of PCCDs were positioned incorrectly. Of the patients with unstable pelvic fractures (n = 18, 100%), more than half either did not receive any PCCD (n = 8, 44%) or had one which was inadequately positioned (n = 2, 11 %). These results underline that preclinical and clinical education programs on PCCD indication and application should be critically reassessed.

Download Full-text

Intraperitoneal Urinary Bladder Rupture as a Cause of Pneumoperitoneum

The American Surgeon ◽

10.1177/00031348211025765 ◽

2021 ◽

pp. 000313482110257

Author(s):

Dar Parvez M ◽

Kour Supreet ◽

Sharma Ajay ◽

Kumar Subodh

Keyword(s):

Urinary Bladder ◽

Primary Repair ◽

Exploratory Laparotomy ◽

Pelvic Trauma ◽

Bladder Rupture ◽

Abdominal Pressure ◽

Trauma Patients ◽

Hollow Viscus ◽

Sudden Rise ◽

Intraperitoneal Bladder Rupture

The most common cause of pneumoperitoneum in trauma patients is hollow viscus injury; however, in patients with pneumoperitoneum on imaging and normal hollow viscus during the laparotomy, other rare causes of pneumoperitoneum like intraperitoneal urinary bladder rupture should be ruled out. Urinary bladder can rupture either extraperitoneally or intraperitoneally or both. Rupture of the urinary bladder is commonly seen in patients with abdominal trauma; however, pneumoperitoneum is usually not seen in patients with traumatic bladder rupture. Intraperitoneal bladder rupture is usually due to the sudden rise in intra-abdominal pressure following abdominal or pelvic trauma. However, it is a rare cause of pneumoperitoneum and is managed by surgical repair. We present a case of blunt trauma abdomen with pneumoperitoneum due to isolated intraperitoneal bladder rupture who was managed by exploratory laparotomy and primary repair of the urinary bladder.

Download Full-text