scholarly journals A Traumatic Direct Inguinal Hernia from Pelvic Ring Disruption

2018 ◽  
Vol 2018 ◽  
pp. 1-3
Author(s):  
Kevin L. Chow ◽  
Eduardo Smith-Singares ◽  
James Doherty
Keyword(s):  
Inguinal Hernia ◽  
Abdominal Wall ◽  
Pelvic Fracture ◽  
Pelvic Ring ◽  
Abdominal Wall Reconstruction ◽  
High Energy ◽  
Pelvic Fractures ◽  
Open Book ◽  
Direct Inguinal Hernia ◽  
Muscle Fascia

Introduction. Pelvic fractures usually involve a high-energy traumatic mechanism and account for approximately 3% of all blunt traumatic skeletal injuries. Additional musculoskeletal injuries are found in over 80% of unstable pelvic fractures. Traumatic abdominal wall hernias (TAWHs) are a rare entity, and traumatic inguinal hernias (TIHs) associated with open-book pelvic fractures have not been described previously.Case Presentation. We present the case of a 45-year-old male motorcyclist involved in a collision resulting in a traumatic direct inguinal hernia due to abdominal wall disruption from an open-book pelvic fracture. He underwent a combined operation with an open reduction and internal fixation (ORIF) of his pelvic fracture and an abdominal wall reconstruction with a modified Stoppa technique utilizing mesh for his hernia.Discussion. This is a unique presentation of a TIH due to an open-book pelvic fracture after blunt abdominal trauma. The formation of TAWH is typically from a combination of local tangential shearing forces and a sudden rise in intraabdominal pressures damaging the muscle, fascia, and peritoneum while the skin remains intact. In patients without hollow viscous injuries and gross contamination, these hernias can be repaired safely with mesh in the acute setting simultaneously with pelvic reduction.

scholarly journals A STUDY ON SKELETALLY IMMATURE UNSTABLE PELVIC FRACTURES IN CHILDREN

2019 ◽  
Vol 3 (1) ◽  
Author(s):  
Dr. Rakesh Kumar Gupta ◽  
Dr. Mohkam Singh
Keyword(s):  
Surgical Treatment ◽  
Pelvic Fracture ◽  
Sacroiliac Joint ◽  
Pelvic Ring ◽  
Health Centre ◽  
High Energy ◽  
Pelvic Fractures ◽  
Severe Bleeding ◽  
Fractures In Children ◽  
Unstable Fractures

Introduction: Out of all factures the pelvic facture showed relatively less which account for 3%. In children Pelvic fractures are relatively rare as less than 0.2% of all paediatric fractures and 1-5% of admissions to tertiary children’s health centre. Pelvis is a structure like a basin shaped bony which supports the spinal column and protects the abdominal organs. It may be facture due to high energy forces such as fall from a height or motor vehicle crash.  Incident of pelvic fracture is increasing and these are associated with a high mortality rate of 25%. There was relatively low rate of occurrence of facture of pelvic injuries that associated with high levels of morbidity and mortality. According to the studied of the post-mortem examined only in children 66 deaths caused by trauma that showing pelvic fracture and severe bleeding to be the cause of death in 42% of the cases. In the case of adult in cases of unstable pelvic fractures retroperitoneal bleeding is the worst complication. When involving emergency situation cases with hemodynamic instability immediate treatment must be conducted using an external fixation, though it is only for temporarily to prioritise controlling the bleeding and saving the patient’s life. Aim: The main objective of this study is to study the surgical treatment for unstable pelvic fractures in children and stabilisation on basic primary care provided at an emergency service. Material and methods: In this study total 10 children patients were included who had suffered unstable fractures of the pelvic ring. From all the patients detail clinical history were taken with analysis of the pre and postoperative radiographs by presence of the triradiate cartilage of the iliac. This study was based on radiographic quantification and the outcome of the residual pelvic and after the surgery treatment using the method of Keshishyan et al[i] for comparison of pre and post operative findings. Result: In this study unstable fractures of the pelvic ring evaluated where female were 7 and male were 3 with the ration 7: 3. The ranges were 2 to 13 years with the mean age 7.2 years old. For all the patients operation was done on an average of 12.3 days after the facture. The maximum cases the initial traumas were due to the run over followed by motorcycle accident and fall from height respectively.  The injuries of the pelvis joint were divided inti anterior and posterior.  Symphysis disjucction of the pubic facture were present in maximum with the facture of two rami and facture of four rami respectively. In five of the cases Sacroiliac dislocation correspond to posterior lesion were seen. Unilateral fractures of the posterior ilium were also seen whereas unilateral anterior opening of the sacroiliac joint was also present. Conclusion: In children facture of pelvic ring is rare and an indication for surgical treatment is unusual.  Their concerns relate  to  the  complications  encountered that in  leg  length  and  residual  pain in  the  sacroiliac  joint. Hence for the justification, this study finding provides justifies the option of surgical treatment for reduction and correction of pelvic deformities, of the pelvic ring at an early stage, at the time of the injury. Keywords: children, unstable pelvic facture, pelvic ring, Pelvic asymmetry

scholarly journals STUDY OF CLINICOPATHOLOGIC PROFILES OF PATIENTS WITH BENIGN BREAST DISEASE

2019 ◽  
Vol 3 (1) ◽  
Author(s):  
Dr. Rameshwar Dayal Goyal ◽  
Dr. Akhlesh Kumar Srivastava
Keyword(s):  
Surgical Treatment ◽  
Pelvic Fracture ◽  
Sacroiliac Joint ◽  
Motor Vehicle ◽  
Pelvic Ring ◽  
Health Centre ◽  
High Energy ◽  
Pelvic Fractures ◽  
Severe Bleeding ◽  
Unstable Fractures

Introduction: Out of all factures the pelvic facture showed relatively less which account for 3%. In children Pelvic fractures are relatively rare as less than 0.2% of all paediatric fractures and 1-5% of admissions to tertiary children’s health centre. Pelvis is a structure like a basin shaped bony which supports the spinal column and protects the abdominal organs. It may be facture due to high energy forces such as fall from a height or motor vehicle crash.  Incident of pelvic fracture is increasing and these are associated with a high mortality rate of 25%. There was relatively low rate of occurrence of facture of pelvic injuries that associated with high levels of morbidity and mortality. According to the studied of the post-mortem examined only in children 66 deaths caused by trauma that showing pelvic fracture and severe bleeding to be the cause of death in 42% of the cases. In the case of adult in cases of unstable pelvic fractures retroperitoneal bleeding is the worst complication. When involving emergency situation cases with hemodynamic instability immediate treatment must be conducted using an external fixation, though it is only for temporarily to prioritise controlling the bleeding and saving the patient’s life. Aim: The main objective of this study is to study the surgical treatment for unstable pelvic fractures in children and stabilisation on basic primary care provided at an emergency service. Material and methods: In this study total 10 children patients were included who had suffered unstable fractures of the pelvic ring. From all the patients detail clinical history were taken with analysis of the pre and postoperative radiographs by presence of the triradiate cartilage of the iliac. This study was based on radiographic quantification and the outcome of the residual pelvic and after the surgery treatment using the method of Keshishyan et al[i] for comparison of pre and post operative findings. Result: In this study unstable fractures of the pelvic ring evaluated where female were 7 and male were 3 with the ration 7: 3. The ranges were 2 to 13 years with the mean age 7.2 years old. For all the patients operation was done on an average of 12.3 days after the facture. The maximum cases the initial trauma were due to the run over followed by motorcycle accident and fall from height respectively.  The injuries of the pelvis joint were divided inti anterior and posterior.  Symphysis disjucction of the pubic facture were present in maximum with the facture of two rami and facture of four rami respectively. In five of the cases Sacroiliac dislocation correspond to posterior lesion were seen. Unilateral fractures of the posterior ilium were also seen whereas unilateral anterior opening of the sacroiliac joint was also present. Conclusion: In children facture of pelvic ring is rare and an indication for surgical treatment is unusual.  Their concerns relate  to  the  complications  encountered that in  leg  length  and  residual  pain in  the  sacroiliac  joint. Hence for the justification, this study finding provides justifies the option of surgical treatment for reduction and correction of pelvic deformities, of the pelvic ring at an early stage, at the time of the injury. Keywords: children, unstable pelvic facture, pelvic ring, Pelvic asymmetry

scholarly journals Epidemiology and aetiology of male and female sexual dysfunctions related to pelvic ring injuries: a systematic review

2021 ◽  
Author(s):  
Giuseppe Rovere ◽  
Andrea Perna ◽  
Luigi Meccariello ◽  
Domenico De Mauro ◽  
Alessandro Smimmo ◽  
...  
Keyword(s):  
Sexual Dysfunction ◽  
Sexual Function ◽  
Pelvic Fracture ◽  
Pelvic Ring ◽  
Pelvic Fractures ◽  
Sexual Dysfunctions ◽  
Fracture Type ◽  
Ring Fracture ◽  
Male And Female ◽  
Pelvic Ring Injuries

Abstract Introduction Pelvic ring injuries, frequently caused by high energy trauma, are associated with high rates of morbidity and mortality (5–33%), often due to significant blood loss and disruption of the lumbosacral plexus, genitourinary system, and gastrointestinal system. The aim of the present study is to perform a systematic literature review on male and female sexual dysfunctions related to traumatic lesions of the pelvic ring. Methods Scopus, Cochrane Library MEDLINE via PubMed, and Embase were searched using the keywords: “Pelvic fracture,” “Pelvic Ring Fracture,” “Pelvic Ring Trauma,” “Pelvic Ring injury,” “Sexual dysfunction,” “Erectile dysfunction,” “dyspareunia,” and their MeSH terms in any possible combination. The following questions were formulated according to the PICO (population (P), intervention (I), comparison (C), and outcome (O)) scheme: Do patients suffering from pelvic fracture (P) report worse clinical outcomes (C), in terms of sexual function (O), when urological injury occurs (I)? Is the sexual function (O) influenced by the type of fracture (I)? Results After screening 268 articles by title and abstract, 77 were considered eligible for the full-text analysis. Finally 17 studies that met inclusion criteria were included in the review. Overall, 1364 patients (902 males and 462 females, M/F ratio: 1.9) suffering from pelvic fractures were collected. Discussion Pelvic fractures represent challenging entities, often concomitant with systemic injuries and subsequent morbidity. Anatomical consideration, etiology, correlation between sexual dysfunction and genitourinary lesions, or pelvic fracture type were investigated. Conclusion There are evidences in the literature that the gravity and frequency of SD are related with the pelvic ring fracture type. In fact, patients with APC, VS (according Young-Burgess), or C (according Tile) fracture pattern reported higher incidence and gravity of SD. Only a week association could be found between GUI and incidence and gravity of SD, and relationship between surgical treatment and SD. Electrophysiological tests should be routinely used in patient suffering from SD after pelvic ring injuries.

scholarly journals Comparison of One-Year Functional Outcomes and Quality of Life between Posterior Pelvic Ring Fixation and Combined Anterior-Posterior Pelvic Ring Fixation after Lateral Compression (B2 Type) Pelvic Fracture

Medicina ◽  
2021 ◽  
Vol 57 (3) ◽  
pp. 204
Author(s):  
Giedrius Petryla ◽  
Valentinas Uvarovas ◽  
Rokas Bobina ◽  
Jaunius Kurtinaitis ◽  
Roma Puronaitė ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Pelvic Fracture ◽  
Functional Outcomes ◽  
Pelvic Ring ◽  
Pelvic Fractures ◽  
Posterior Pelvic Ring ◽  
Sf 36 ◽  
One Year ◽  
Anterior Posterior

Background and Objectives: The treatment algorithm of lateral compression B2 type pelvic fractures are still under debate. Some authors advocate conservative treatment, while others recommend surgical approach. The clear indications for isolated anterior or posterior ring fixation or combined anterior-posterior pelvic ring fixation of B2 type fractures remain unclear. The aim of this study was to compare the functional outcomes and quality of life after isolated posterior pelvic ring fixation and combined anterior-posterior pelvic ring fixation for the treatment of B2 pelvic fractures. Materials and Methods: Patients aged 18 to 65 years with B2 type pelvic fracture hospitalized in a single trauma centre over a period of 3 years were included in the research. Based on the attending surgeon’s preference, patients were treated with isolated posterior or combined anterior-posterior pelvic fixation. The quality of life and pelvic function were assessed using SF-36 and Majeed questionnaires, respectively. Patients filled in the questionnaires twice: during the first hospitalization (concerning their pre-trauma state—timepoint I) and one-year after the injury (timepoint II). Results: A cohort of 32 patients with B2 type pelvic fracture was enrolled in the analysis: 23 (72%) were female and 9 (28%) were male. The mean age was 35.3 ± 11.9 years. In this cohort 13 (41%) patients underwent isolated posterior pelvic ring fixation (group I) and 19 (59%) patients underwent combined anterior-posterior pelvic ring fixation (group II). No statistically significant differences were observed between the groups in both timepoints concerning Majeed, SF-36 PCS and MCS scores. However, in both groups Majeed and SF-36 PCS scores were statistically significantly lower one year after pelvic fracture compared with pre-trauma state, while SF-36 MCS scores did not differ. Conclusions: No differences were found in quality of life and functional outcomes between isolated posterior pelvic ring fixation and combined anterior-posterior fixation for the treatment of B2 type pelvic fractures.

Pre-hospital and emergency department management of pelvic fractures and major trauma centre status: Has practice changed?

Trauma ◽  
2016 ◽  
Vol 19 (3) ◽  
pp. 207-211
Author(s):  
Jonathan Barnes ◽  
Philip Thomas ◽  
Ramsay Refaie ◽  
Andrew Gray
Keyword(s):  
Emergency Department ◽  
Clinical Practice ◽  
Pelvic Fracture ◽  
Major Trauma ◽  
High Energy ◽  
Trauma Centre ◽  
Pelvic Fractures ◽  
Major Trauma Centre ◽  
Initial Imaging ◽  
One Year

Introduction Pelvic fractures are indicative of high-energy injuries and carry a significant morbidity and mortality and pelvic binders are used to stabilise them in both the pre-hospital and emergency department setting. Our unit gained major trauma centre status in April 2012 as part of a national programme to centralise trauma care and improve outcomes. This study investigated whether major trauma centre status led to a change in workload and clinical practice at our centre. Methods A retrospective analysis of all patients admitted with a pelvic fracture for the six-month periods before, after and at one-year following major trauma centre status designation. Data were retrospectively collected from electronic patient records and binder placement assessed using an accepted method. Patients with isolated pubic rami fractures were excluded. Results Overall, 6/16 (37.5%) pelvic fracture admissions had a binder placed pre-major trauma centre status, rising to 14/34 (41.2%) immediately post-major trauma centre status and 22/32 (68.8%) ( p = 0.025) one year later. Binders were positioned accurately in 4 patients (80%, one exclusion) pre-major trauma centre status, 12 (92.4%) post-major trauma centre status and 22 (100%) at one year. CT imaging was the initial imaging used in 9 (56.3%) patients pre-major trauma centre status, 29 (85.3%) ( p = 0.04) post-major trauma centre status and 27 (84.4%) at one year. Discussion Pelvic fracture admissions doubled following major trauma centre status. Computed tomography, as the initial imaging modality, increased significantly with major trauma centre status, likely a reflection of the increased resources made available with this change. Although binder application rates did not change immediately, a significant improvement was seen after one year, with binder accuracy increasing to 100%. This suggests that although changes in clinical practice often do not occur immediately, with the increased infrastructure and clinical exposure afforded through centralisation of trauma services, they will occur, ultimately leading to improvements in trauma patient care.

scholarly journals Management and outcome of pelvic fracture associated with vaginal injuries: a retrospective study of 25 cases

2019 ◽  
Author(s):  
Pengyu Li ◽  
Dongsheng Zhou ◽  
Baisheng Fu ◽  
Wenhao Song ◽  
Jinlei Dong
Keyword(s):  
Retrospective Study ◽  
Pelvic Fracture ◽  
Influence Factor ◽  
Pelvic Ring ◽  
Delayed Diagnosis ◽  
Pubic Symphysis ◽  
Pelvic Fractures ◽  
Urethral Injury ◽  
Pelvic Ring Fractures ◽  
Vaginal Injury

Abstract Backgound: Pelvic ring fractures associated with vaginal injuries were rarely reported due to low incidence. The displaced segments of pelvic ring may increase the risk of vaginal injury. The aim of this retrospective study was to evaluate the correlation between pelvic fracture and vaginal injury. Methods: We conducted a retrospective review of 25 patients with pelvic fractures associated with vaginal injury treated at our institution. The medical records of these patients were collected and 24 patients were followed-up for 10-36 months. Results: All patients suffered anterior pelvic ring fracture. Young-Burgess fracture classification and compromised pubic symphysis were related to severity vaginal injury. Gauze packing was done in 6 patients and 18 patients received surgical repair. Infection occurred in 6 patients among them 4 were due to delayed diagnosis. Factors associated with pelvic outcome were age, urethral injury, and infection. Four patients suffered pain in sexual intercourse but no influence factor found correlated to sexual function. Conclusion: VS type pelvic fractures and compromised pubic symphysis are related to higher severity of vaginal injury. Disruption of anterior ring and an unstable pelvic ring caused by forces on coronary and axial plane may increase the risk of vaginal injury. Key words: Pelvic fracture, Vaginal injury, Clinical outcome

scholarly journals RECTAL CULTURE SURVEILLANCE AND DEVELOPED SYSTEMIC INFECTIONS IN VANCOMYCIN-RESISTANT ENTEROCOCCI AND CARBAPENEM-RESISTANT KLEBSIELLA PNEUMONIAE CARRIERS

2019 ◽  
Vol 3 (1) ◽  
Author(s):  
Çiğdem Arabacı ◽  
Salih Emre
Keyword(s):  
Pelvic Ring ◽  
High Energy ◽  
Pelvic Fractures ◽  
Young Age ◽  
Economic Losses ◽  
Severe Bleeding ◽  
Care Hospital ◽  
Age Group ◽  
High Energy Trauma ◽  
Unstable Fractures

Introduction: Globally, in the young age group of people mortality and morbidity is due to the high-energy trauma.  The losing of young age group of population will get impact in the social economic losses of family as well as the nation. Fractures are generally caused by high-energy trauma, high-impact accidents and are often associated with injuries to other organic lesions like abdominal viscera, genitourinary system, neurovascular, musculoskeletal structures and central nervous system. There was relatively low rate of occurrence of facture of pelvic injuries that associated with high levels of morbidity and mortality. According to the studied of the post-mortem examined only in children 66 deaths caused by trauma that showing pelvic fracture and severe bleeding to be the cause of death in 42% of the cases. In the case of adult in cases of unstable pelvic fractures retroperitoneal bleeding is the worst complication. Aim: The main objective of this study is to study of Unstable Pelvic Fractures from children in tertiary care hospital Material and methods: In this study total 10 patients were included who had suffered unstable fractures of the pelvic ring with the age from  1 to 15 years old.. From all the patients detail clinical history were taken with analysis of the pre and postoperative radiographs by presence of the triradiate cartilage of the iliac. Result: In this study total 10 patients were included with unstable fractures of the pelvic ring evaluated where female were 6 and male were 4 with the ration 6: 4. The age ranges were 2 to 15 years with the mean age 7.5±4 years old. Symphysis disjunctions of the pubic facture were present in maximum with the facture of two rami and facture of four rami respectively. In five of the cases Sacroiliac dislocation correspond to posterior lesion were seen. The AO-OTA classification was used to evaluate the cases with the following distribution as 61 B1 (one case); 61 B2 (one case); 61 C3 (one cases), 61 C2 (one case) and 61 C1 (seven cases). Conclusion: Now  a day’s also many research which still have a controversy  for treatment,  which  has  been  recommended  for  treating  these  fractures  for  many  years. Their concerns relate  to  the  complications  encountered that in  leg  length  and  residual  pain in  the  sacroiliac  joint. Keywords:  unstable pelvic facture, pelvic asymmetry, children

scholarly journals Accuracy of the WSES classification system for pelvic ring disruptions: an international validation study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Szu-Han Wang ◽  
Chih-Yuan Fu ◽  
Francesco Bajani ◽  
Marissa Bokhari ◽  
Justin Mis ◽  
...  
Keyword(s):  
Vascular Injury ◽  
Pelvic Fracture ◽  
Pelvic Ring ◽  
Mortality Rates ◽  
Pelvic Fractures ◽  
Vascular Injuries ◽  
Infection Rates ◽  
Pelvic Ring Injuries ◽  
Closed Fractures ◽  
Unstable Pelvic Ring Injuries

Abstract Background In 2017, a novel classification for pelvic injuries was established by the World Society of Emergency Surgery (WSES). We validated its effectiveness using nationwide real-world data. The roles of associated vascular injury and open fracture in this system were also evaluated. Methods Patients with pelvic fractures in the National Trauma Data Bank 2015 dataset were retrospectively studied. First, the mortality rates were compared by WSES classification. Second, independent predictors of mortality were evaluated using a multivariate logistic regression model. Patients with and without associated vascular injuries and the same hemodynamic and pelvic ring stability statuses were compared. Patients with associated vascular injuries were compared to the proportion of nonsurvivors and survivors with unstable pelvic ring injuries. Third, the outcomes were compared between patients with open pelvic fracture and closed pelvic fracture in the mild, moderate and severe WSES classes. Results During the 12-month study period, 44,163 blunt pelvic fracture patients were included. The mortality rates were 1.8%, 3.8% and 10.6% for the mild, moderate and severe WSES classes, respectively (p < 0.001). MLR analysis showed that unstable pelvic ring injury did not significantly affect mortality (p = 0.549), whereas open pelvic fracture and associated vascular injury were independent predictors of mortality (odds of mortality: open pelvic fracture 1.630, p < 0.001; associated vascular injury 1.602, p < 0.001). Patients with associated vascular injuries showed that there was no significant difference in the proportion of patients with unstable pelvic ring injuries between survivors and nonsurvivors (37.2% vs. 32.7%, p = 0.323). In all three classes, patients with open pelvic fractures had significantly higher mortality rates and infection rates than patients with closed fractures (mortality rates: minor 3.5% vs. 1.8%, p = 0.009, moderate 11.2% vs. 3.3%, p < 0.001, severe 23.8% vs. 9.8%, p < 0.001; infection rates: minor 3.3% vs. 0.7%, p < 0.001, moderate 6.7% vs. 2.1%, p < 0.001, severe 7.9% vs. 2.8%, p < 0.001). Conclusions Based on this nationwide study, the WSES guideline provides an accurate and reproducible classification of pelvic fractures. It is recommended that open/closed fractures and associated vascular injuries be evaluated as supplements of the WSES classification.

Management of urological trauma associated with pelvic fractures

2021 ◽  
Vol 82 (1) ◽  
pp. 1-9
Author(s):  
Amaury Trockels ◽  
Aashish K Ahluwalia ◽  
Andrew Chetwood
Keyword(s):  
Pelvic Ring ◽  
High Energy ◽  
Pelvic Fractures ◽  
Initial Assessment ◽  
Urethral Injury ◽  
Bladder Rupture ◽  
Collaborative Management ◽  
High Incidence ◽  
Pelvic Ring Disruption

Urological trauma is frequently encountered in patients with high energy pelvic fractures and can have debilitating long-term sequelae for patients without appropriate multidisciplinary management. Anterior pelvic ring disruption causes a high incidence of bladder rupture and urethral injuries, and initial assessment requires urological tract imaging and emergent bladder drainage before subsequent surgical repair. Pelvic ring disruption requires urgent fixation and should be managed as an open fracture in the context of significant bladder and urethral injury with urinary leakage. Long-term outcomes are variable and genitourinary dysfunction is commonly reported among patients with pelvic fractures. Optimisation of patient outcomes relies heavily on collaborative management between orthopaedic and urological specialists and requires an appreciation of the anatomical intricacies of the pelvis. This article provides an overview of the British Orthopaedic Association Standards for Trauma and Orthopaedics management of urological trauma in the context of pelvic fractures.

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