Presentation and management outcomes of pelvic fractures: a single institutional review

Background: Pelvic fractures are orthopaedic emergencies associated with polytrauma. These fractures have gradually increased in recent times as a result of increasing high speed and complex road traffic accidents. Objective: To describe the presentation and management outcome of patients that were managed in our institution for pelvic fractures over the study period. Methodology: We retrospectively reviewed the hospital records of patients who were admitted and treated in our hospital with pelvic injuries from February 2012 to January 2015. Results: Majority 122 (75.8%) of the patients in this study were aged below 40 years. These fractures were mostly caused by road traffic accidents. Most 116 (71.9%) of our patients had Tile class A and B fractures. Polytrauma seen in 41.6% of the patients was the most common associated injury seen with pelvic fractures. The mean Injury Severity Score (ISS) 31.4 shows that these patients were mostly severely injured patients. The fatality rate in this study was 16.12%. These mortality were higher for patients with Tile class C than B injury and no death was recorded for class A injuries. Conclusion: Majority of the patients were less than 40 years and Road Traffic Accident is the commonest aetiology. Many were successfully managed conservatively particularly those with stable and partially stable injuries. Functional outcome is generally good

Haemodynamically unstable pelvic trauma: initial validation of a dedicated protocol by a retrospective cohort study with historical controls

Background: We present our experience after the introduction of Advanced Trauma Life Support (ATLS)©, Trauma Team (TT) and Preperitoneal Pelvic Packing (PPP) protocols for the treatment of hemodynamically unstable pelvic blunt trauma.Methods: This is a retrospective study with historical controls: before (Control Group, CG) and after (Study Group SG) the introduction of the protocol. A single physician managed the CG and angiography was the emergency manoeuvre. A team with ATLS guidelines and PPP as an emergency manoeuvre managed the SG. Data were collected retrospectively. Patients were divided into two groups: before and after the introduction of protocols.Results: From January 2007 to October 2014, 36 patients were treated at our Centre. We consider patients from January 2007 to August 2011 (19 patients, CG) and from September 2011 to October 2014 (17 patients, SG). Median age was 54 years (43­69) in the CG vs. 47 (40­63) in the SG (p = 0.43), median initial SBP 90 mmHg (85­103) in the CG 94 (69­103) in the SG, (p = 0.60), heart rate was 90 (80­110) in the CG and 110 (95­130) in the SG, (p = 0.09). Median Injury Severity Score was 33 (21­41) in the CG and 34 (26­41) in the SG (p = 0.29). Time from arrival in the Emergency Department to first therapeutic manoeuvre was 132 minutes (109­180) in the CG and 87 minutes (51­204) in the SG (p = 0.4). The difference in mortality was statistically significant: 64.7% (11/17) in the CG and 23.5% (4/17) in the SG (p = 0.02).Conclusions: The introduction of protocols changed our approach in hemodynamically unstable pelvic trauma, achieving a remarkable improvement in early mortality

Les complications urologiques liées à la chirurgie pelvienne au CHU du Point-G, à propos de 23 cas

Introduction : Les lésions vésicale et urétérale constituent les complications urologiques les plus fréquentes survenant au décours d'une chirurgie pelvienne soit respectivement 1 à 4% et 0,5 à 3% [6,7]. Ces lésions sont rarement reconnues en peropératoire et posent un problème important auquel sont confrontés les urologues, les gynécologues, les chirurgiens généralistes. Objectif : Etudier les facteurs favorisants les complications urologiques consécutives à la chirurgie pelvienne au CHU du Point-G. Patientes et Méthode : Il s'agissait d'une étude rétrospective réalisée au CHU du Point-G entre 2006 et 2015. Elle a concerné 23 patientes présentant toute une lésion urologique au décours d'une chirurgie pelvienne. Ces patientes ont subi un examen clinique et para cliniques (Urographie intra veineuse ; le test au bleu de méthylène) dans le but de confirmer la lésion urologique et d'en déterminer la prise en charge. Résultats : l'âge moyen de nos patientes était de 32,00 ans avec des extrêmes allant de 18 à 40 ans. La fuite d'urine était retrouvée chez 82,6% (19/23). Les interventions pourvoyeuses de lésions urologique étaient : la césarienne 52, 2% (12/23), l'hystérectomie 30, 4% (7/23), une association césarienne et hystérectomie 17,4 % (4/23). Le test au bleu de méthylène a été réalisé chez 19 patientes, il a été positif dans 12 cas soit 52,2 % et l'UIV chez 7 patientes. Les lésions rencontrées étaient : la fistule vésico-vaginale retro trigonale 10 cas, la fistule vésico-vaginale sous trigonale 2 cas, la fistule urétéro-vaginale 7 cas, et la ligature urétérale bilatérale 4 cas. La fistulorraphie a été effectuée dans 52,2 % suivie de la réimplantation urétéro-vésicale directe. Les suites opératoires étaient satisfaisantes dans 100% des cas avec l'obtention d'une bonne étanchéité vésicale. La durée moyenne d'hospitalisation était de 12 jours (+/- 4 jours). Conclusion : La chirurgie pelvienne est pourvoyeuse de lésions urologiques. La césarienne et l'hystérectomie sont des facteurs favorisants. Les fistules vésico-vaginales ou des lésions urétérales sont fréquentes

"Gunshot injury to the pelvis".The bullet voided through the urethra

Gunshot injuries (GSIs) are considered as an emergency and life threatening. The gunshots injuries to the urinary tract are uncommon. The high-velocity of bullet can cause both a penetrating injury to the target organs as well as blast injury to nearby structures, in addition to thermal injuries. In most of the cases, laparotomy is required to remove the bullet and to repair the injuries. The phenomenon of spontaneous migration of retained bullet to different parts of body has been described in the medical literature. Here, we present a patient who sustained penetrating GSI to the pelvis, without organ injuries, including the bladder. The bullet initially was retained within peri-vesical fat and the bladder wall while the mucosa remained intact, then it migrated into the bladder and came out through the urethra during voiding on the sixth day after injury

Apport de la radiographie conventionnelle dans les traumatismes de l'extrémité supérieure du fémur et du bassin de l'adulte dans un hôpital de district au Togo

Objectifs : Etablir le profil épidémiologique des traumatisés, répertorier et décrire les caractéristiques des lésions visibles à la radiologie conventionnelle. Matériels et méthodologie : Il s'est agi d'une étude prospective et analytique de 12 mois (mai 2010 à avril 2011) concernant l'analyse radiographique de 302 examens de la hanche ou du bassin traumatique de l'adulte, colligés dans un service de radiologie d'un centre hospitalier préfectoral. Résultats : Il était noté une prédominance masculine avec sex-ratio 2,6. L'âge moyen des patients était de 60 ans avec des extrêmes de 18 à 95.Les accidents de la voie publique (AVP) dans 60,26% constituaient les plus fréquentes circonstances de survenue des lésions dont la fréquence était de 39,40 %.La radiographie du bassin de face en position couchée (100%), le profil urétral (25%),) et le profil chirurgical d'Arcelin (2,3%) ont été réalisés. Les lésions répertoriées étaient les fractures trochantériennes (40,33 %), les fractures cervicales (30,25 %), les fractures du cotyle (15,9 %) et les luxations (13,44 %). Au niveau du massif trochantérien, les traits de fractures étaient obliques (33,33%), multi-fragmentaires (25%), spiroïdes(22,91%). Au niveau du cotyle les traits dominants étaient obliques (42, 21%) et transversales (36,84 %) . Les fractures du col étaient classées en Garden I (20%), Garden II (,4%), Garden III (48%) et Garden IV (28 %). Les luxations postérieures étaient prédominantes dans 68,75% vs 31,25% de formes antérieures. Conclusion La radiographie conventionnelle reste est un outil de diagnostic indispensable et incontournable dans l'exploration de la pathologie traumatique de la hanche dans les situations d'urgence surtout en milieu rural où font défaut les moyens d'imagerie en coupe et les mains qualifiées

Facteurs predisposant au traitement chirurgical dans la prise en charge de la pelviperitonite a Yaounde; Cameroun

Contexte et objectifs: Les facteurs d'echec de l'antibiotherapie en cas de pelviperitonite sont peu connus. L'objectif de cette etude etait de determiner les facteurs predisposant du traitement chirurgical dans la prise en charge de la pelviperitonite. Methodologie: Il s'agissait d'une etude cas-temoins avec collecte retrospective des donnees; concernant tous les cas de pelviperitonite traitees a l'Hopital Gyneco-Obstetrique et Pediatrique de Yaounde du 1er janvier 2007 au 31 decembre 2011. Resultats: Quatre-vingt-douze malades ont ete incluses; parmi lesquelles 75 patientes (75/92 ; 81;5) n'avaient recu que le traitement medical (groupe temoin) et dix-sept (17/92 ; 18;5) avaient necessite une prise en charge chirurgicale (groupe cas); soit une incidence de la chirurgie dans le traitement des pelviperitonites de 18;5. Les facteurs predisposant au traitement chirurgical etaient: un age 25 ans [P

Pelvic Types As Seen in a Tropical Setting

Background: Cephalo pelvic disproportion is still the leading indication for caesarean section in many developing countries and the contribution of pelvic typology may play some role in this regard. Our objective is to determine the proportion of pelvic types as seen in a tropical setting. Method: A retrospective review of preliminary films of hysterosalpingography of 400 women who underwent the study between January 2000 and December 2007 was reviewed to determine the pelvic typology. Result: Of the 400 films reviewed; 361(90.3) were gynaecoid; 36 (9) were android and 3 (0.8) were andropoid. There was no platypelloid pelvis seen in the films reviewed and a mixed type pattern was not observed in this study. Conclusion: The proportion of pure gynaecoid pelvis seen in this review is about the highest reported in the literature

Urological Injuries during Pelvic Surgery in Women; Gezira; Central Sudan

Injuries to the ureter and bladder are common in female pelvic surgery; sometimes extremely common to be considered as traditional. This is a retrospective study conducted in Gezira Hospital for Renal Disease and Surgery; Medani Teaching Hospital and Medani Maternity Hospital; #ad Medani; Sudan. #e included $paetents 'ith urological injuries follo'ing obstetrical gynecology interveneton in the previous ( years. The interaoperaetve injuries consettuted; -.; 'hile the remote injuries 'ere 6+7(.6 -.. #e conclude that the urological injuries are common complications during pelvic surgery; associated mainly 'ith abdominal hysterectomies and Cesarean section

Hinged Transpubic Approach to Delayed Repair of Posterior Urethral Distraction Defects Complicating Pelvic Fractures - Preliminary Experience

Objective: To present our experience with a transpubic approach to the management of one of the most challenging injuries of the lower urinary tract. Patients and Methods: Between January 2003 and December 2005; 7 patients presenting to our unit with complex urethral distraction defects due to type 2 or 3 posterior urethral disruption injuries complicating pelvic fracture were included in an ongoing evaluation of the transpubic approach to the repair of such defects. The patients had a mean age of 37.7 (range 22 - 56) years and were followed up for 1 - 4 years. Results: After the follow-up period 4 patients had a very successful outcome with trouble-free voiding. Three developed stric-tures; two of which were successfully managed with regular dilatation; while the third patient became catheter-dependent following dilatation and inadvertent creation of a false passage. This patient underwent a successful re-operation with full recovery. Conclusion: The transpubic approach to delayed repair of urethral distraction defects complicating pelvic fracture is feasible. It allows an effective dissection of the dense hematoma-fibrosis that commonly complicates these injuries at a later stage. The approach is particularly useful in complex long-standing defects where such dissection is made relatively easy by the ample working space provided. The successful outcome of treatment by this approach in 4 and ultimately 5 out of 7 patients offers a reasonable degree of salvage for patients with an otherwise poor prognosis. Further studies are warranted to confirm our positive results