PMC7728485_01
(a) Axial head CT scan indicating hyperdense fluid in the lateral ventricles. (b, c) Sagittal and coronal CT planes' indication on the spinopelvic dislocation and the unstable dorsal pelvic ring with a transiliosacral fracture on the right side and a transforaminal component on the left side. (d, e) 3D reconstruction of the CT scan showing the spinopelvic dislocation and sacral burst fracture (S2/3).
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It revealed a hyperdense fluid collection in the lateral and dorsal ventricles (Figure 1(a)). The CT scan of the pelvis showed a persistent spinopelvic dislocation with the sacral burst fracture suggesting a dural tear as cause of the intrathecal fat embolism (Figures 1(b)-1(e)).
(a) Anteroposterior X-ray of the pelvis at time of administration. (b) 3D-CT reconstruction indicating the instability of the dorsal pelvic ring with a gaping right SI joint. (c) Postoperative anteroposterior X-ray and corresponding 3D-CT reconstruction (d) after plating of the right SI joint and modification of the supracetabular external fixator.
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Due to the persistent hemodynamic instability and the remaining biomechanical instability of the dorsal pelvic ring (Figures 2(a) and 2(b)), we performed an immediate surgery with plating of the right SI joint and modification of the supraacetabular external fixator (Figures 2(c) and 2(d)).
(a) Patient in the prone position with large hematoma indicating the Morel-Lavallee lesion. (b, c) Intraoperative pictures showing the sacral dural tear.
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The soft tissue showed serious contusion marks as shown in Figure 3(a). The spinopelvic complex was completely unstable in coronal, horizontal, and sagittal plane (Figures 3(b) and 3(c)).
Postoperative radiological analysis. (a) Anteroposterior X-ray of the pelvis. (b)- (f) 3D-CT reconstruction showing the adequate reduction by lumbopelvic stabilization and the anterior acetabular column screw.
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The postoperative CT scan showed an adequate reduction of the sacrum as well as all implants in the right position (Figures 4(a)-4(f)).
(a) Intraoperative situation after partial resection of the left iliac bone. (b) Anteroposterior X-ray of the pelvis with the bone cement spacer in place.
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The lateral iliac screw was stabilized by a reconstruction of the os ilium with bone cement containing both gentamicin and vancomycin (Figures 5(a) and 5(b)).
Clinical situation 9 months posttrauma showing the fully healed free muscle flap and skin graft.
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The flap and skin autograft procedure were performed, which both healed in properly (Figure 6).