PMC8112908_01
Initial anteroposterior pelvis X-ray showing bilateral pubic rami fractures and a large uterine fibroid, in a 65-year-old patient pedestrian struck by a motor vehicle.
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The patient was known to have a history of uterine fibroid which was visualized on the pelvic radiograph (Figure 1).
Picture showing the vaginal laceration through which the fractured bony fragment was assessed for irrigation and debridement.
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OB/GYN performed vaginal examination and identified several lacerations: (a) 7 o'clock partial thickness tear; (b) 5 o'clock two-inch-deep, full-thickness laceration communicating with the left inferior pubic rami fracture (Figures 2 and 3); (c) 3 cm area of dead space surrounding the fractured edge.
Primary closure of open vaginal wall injury.
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OB/GYN performed vaginal examination and identified several lacerations: (a) 7 o'clock partial thickness tear; (b) 5 o'clock two-inch-deep, full-thickness laceration communicating with the left inferior pubic rami fracture (Figures 2 and 3); (c) 3 cm area of dead space surrounding the fractured edge.
Surgeon made antibiotic-coated Polymethyl methacrylate (PMMA) beads surrounded by metronidazole gel.
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The OB/GYN team performed closure of the vaginal wound and packed the vagina with a gauze roll coated with metronidazole gel, as per standard of care (Figure 4).
Anteroposterior pelvis radiograph showing the external fixator in place and the antibiotic beads surrounding the left inferior pubic rami fracture.
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Final images demonstrated acceptable positioning of the pelvic ring and placement of antibiotic beads (Figure 5). The patient maintained external fixation placement for 8 weeks (Figure 5), weight-bearing as tolerated (WBAT) on the right, and toe touch weight-bearing (TTWB) on the left.
Anteroposterior pelvis radiograph after removal of the external fixator with healing of pubic rami fractures and presence of the antibiotic beads.
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The patient was ambulating well with minimal discomfort (Figure 6).