PMC5852918_01
Malposition of both legs
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F1
The left leg was flexed, adducted, and internally rotated [Figure 1].
"Lodox" shows bilateral hip dislocation (right: anterior-inferior, left: Posterior) and the herniation of visceral organs into the left hemithorax
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F2
Whole-body radiograph with "Lodox" [Figure 2] in the emergency room showed a diaphragmatic rupture with herniation of visceral organs to the left hemithorax, bilateral superior, and inferior pubic rami fractures and bilateral asymmetric hip dislocation.
Computed tomography scans showing the bilateral superior and inferior pubic rami fractures (a - coronal plane, b - axial plane) as well as the bilateral hip dislocation (c - coronal plane) with an anteroinferior dislocation on the right side (d - axial plane) and a posterior dislocation on the left side (e - axial plane)
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F3
A full-body CT scan confirmed the pelvic fractures, the bilateral hip dislocation [Figure 3], and the rupture of the left diaphragm with herniation of stomach, spleen, and the colon transversum to the left hemithorax [Figure 4].
Computed tomography scan with traumatic diaphragmatic rupture and herniation of stomach into the left hemithorax, before (a - coronal, b - axial) and after operation (c - coronal, d - axial)
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F4
A full-body CT scan confirmed the pelvic fractures, the bilateral hip dislocation [Figure 3], and the rupture of the left diaphragm with herniation of stomach, spleen, and the colon transversum to the left hemithorax [Figure 4].
Intraoperative view after suturing the diaphragm
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F5
Visceral surgeons achieved hemostasis of the spleen, sutured the diaphragm [Figure 5], serosal and mesenteric lesions of the sigma, and the colon transversum through midline laparotomy.
Postoperative anteroposterior pelvis X-ray after closed reduction of both hips and osteosynthesis of the anterior pelvic ring (a) and 12 months after injury (b)
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F6
Finally, the superior pubic rami fractures were stabilized with a reconstruction plate bridging the symphysis [Figure 6].