PMC5522959_01
Early stabilization of patient upon admission. A, emergency fixation using pelvic binder seen from the antero-posterior projection; B, left hip skin avulsion with muscle based and skin loss; C, closed degloving injury of the right hip with Morell Lavallee lesion.
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First case was an 11 years old boy with pelvic fracture Torode and Zeig IV or Marvin Tile C1 who had right sacroiliac joint disruption, bilateral superior and inferior pubic rami fracture with soft tissue injuries of skin avulsion on the left hip and closed degloving with Morel-Lavallee lesion on the right hip (Fig. 1, Fig. 2).
Pre-operative CT-3D reconstruction of the pelvic ring showing disruption of the right sacroiliac joint, fracture of the bilateral superior pubic rami and right inferior pubic rami.
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After early management using pelvic binder, vigorous resuscitation, and skin avulsion debridement on the ER, we obtain pre-operative CT 3-dimension scan for the fracture configuration (Fig. 3).
Intraoperative imaging of the percutaneous IS screw insertion. A, image intensifier position to obtain the lateral projection; B, fracture fragment reduction; C, guide wire insertion on the S1 level; D, IS screw insertion on S1 level; E. IS S1 position evaluation on lateral projection.
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The position was continuously changed between AP, inlet, outlet, and Judet view to check the implant position and fracture configuration (Fig. 4).
Post surgery pelvic radiograph showing bilateral fixation of pubic rami and IS screw fixation on S1 and S3 with no observable sacroiliac displacement and return of pelvic ring integrity. A, Anteroposterior view; B, Inlet view; C, Outlet view.
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After 21 months of follow up there was excellent outcome Majeed score 100 and very good outcome of 4 out of 4 by Hannover score (Fig. 5).
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A, B. Skin loss at anterolateral thigh-pelvic-flank exposing necrotic muscle, fascia and bone. C, Morell-Lavallee lesion on posterior thigh.
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Patient presented with skin loss at anterolateral thigh-pelvic-flank sized 30 x 10 cm and Morrell-Lavallee lesion on posterior thigh with necrotic muscle, fascia and bone exposed (Fig. 6, Fig. 7).
A, Pre-operative pelvic radiograph view. A, Pelvic antero-posterior; B, Pelvic inlet; C, Pelvic outlet.
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Seven hours prior to accident patient haemodynamic had returned and we performed open reduction and internal fixation (ORIF) for the anterior pelvic ring with percutaneous screw followed with insertion of iliosacral screw using sacral type to fix the sacral fracture on S1 and S3 level (Fig. 8).
Post-operative pelvic radiograph showing fixation of bilateral superior pubic rami and fixation of S1 and S3. A, anteroposterior view; B, inlet view; C, outlet view.
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Pohlemann radiographic score was 3 out of 3 and clinical score was 3 out of 4 (Fig. 9).