Pelvic Bone Fracture with Bladder Rupture / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate the injury mechanism of pelvic bone fracture and injury type and treatment of bladder rupture associated with pelvic bone fracture. MATERIALS AND METHODS: From September 2002 to February 2011, we treated pelvic bone fracture with bladder rupture in 56 cases with minimal follow up of one year. Each of the 56 cases was classified into groups depending on the mechanism of pelvic fracture (Young classification) and the aspect of bladder rupture (intraperitoneal rupture, extraperitoneal rupture, combined rupture) after which the relationship between the two aspects was analyzed retrospectively. RESULTS: There were a total of 56 cases where bladder ruptures occurred in association with pelvic bone fractures; 34 patients were men and 22 patients were women. The average age was 58.2 years (range: 19-84). Traffic accidents were the main cause of pelvic bone fractures with bladder ruptures in 41 cases. The main injury mechanism was lateral compression, and pubic ramus fractures occurred in 38 cases (67.9%). Regarding the classifications of bladder ruptures, there were 17 cases of intraperitoneal rupture, 37 cases of extraperitoneal rupture, and two cases of combined rupture. Operations were performed on all cases of intraperitoneal and combined rupture and on six cases of extraperitoneal rupture. CONCLUSION: Lateral compression was the most common injury of bladder rupture in pelvic bone fracture. Bladder ruptures occurred even in cases where the displacement of pelvic bones was not severe and also in cases of low energy injury.

Osteonecrosis of Femoral Head after Pelvic Fracture: A Case Report / 대한정형외과학회잡지

We report on a case of osteonecrosis of the femoral head after a traumatic pelvic injury, and this was not associated with skeletal injuries to his hip joint. An adolescent male developed ostenecrosis of the femoral head following a pelvic fracture, but his hip joint was not injured by the pelvic fracture. To the best of our knowledge, such a finding has not been previously reported. The risk factors fot osteonecrosis are also reviewed.

Clinical Profiles of Patients who Undergone Emergency Angiographic Embolization at Emergency Department

PURPOSE: Hemodynamically unstable pelvic fractures represent therapeutic challenges for the trauma team. The authors of this article have studied the clinical profiles of the angiographic intervention population at the emergency department during four years (2005~2009) to develop clinical guidelines for preventing deaths due to multiple trauma and for predicting the prognosis during initial evaluation. METHODS: We performed a retrospective review of 34 patients who had undergone angiographic interventions at the emergency department and compared the differences in clinical variables between survivors and non-survivors. RESULTS: Representative values were compared between survivors and non-survivors : RTS (revised trauma score) 7.006 (6.376~7.841) vs. 6.128 (4.298~6.494), PRC (packed red cell) units 5.5 (2.0~11.0) vs. 15 (8.0~18.5), and lactate (mmol/L) 3.0 (1.0~7.0) vs. 8.5 (3.5~10.5). RTS (p<0.01) and PRC units before angiographic interventions (p=0.01) and lactate (p=0.02) had correlations to the final outcomes. CONCLUSION: The availability of an angiographic suite and persistent hypotension after adequate fluid resuscitation for pelvic trauma are good indications of angiographic intervention for pelvic hemorrhage.

Effectiveness of Arterial Embolization in Hemodynamically Unstable Pelvic Fracture

Purpose: To assess the effectiveness and appropriate time for arterial embolization with angiography in patients who sustained a hemodynamically unstable pelvic bone fracture Materials and methods: Nineteen cases with hemodynamically unstable pelvic bone fractures that were managed with arterial embolization out of 287 pelvic bone fractures between May, 2002 and February, 2007 were reviewed retrospectively. The blood pressure, pulse rate, hemoglobin, prothrombin time, partial prothrombin time and platelet checked were evaluated immediately after arrival at the emergency room, before and after embolization. Repeated measures analysis of variance was used for the statistical evaluation. Results: The blood pressure showed a statistically significant increase from before and after embolization. The hemoglobin and prothrombin time checked upon arrival were significantly lower than those checked before embolization. In addition, the hemoglobin and prothrombin time was significantly higher before embolization than after embolization. The partial thromboplastin time and platelet checked immediately upon arrival were significantly lower than those checked before embolization. Conclusion: Interventional angiography and embolization can be an effective treatment modality in patients with hemodynamically unstable pelvic bone fractures showing rapid changes in the hemoglobin level, prothrombin time, partial thromboplastin time and platelet count but little response to fluid and transfusion resuscitation,.

Noninvasive Reduction of Fractures of Pubis and Separation of Symphysis Pubis by Circumferential Pelvic Belt: A case report

Early reduction and stabilization of the pelvic bone after traumatic unstable pelvic bone fracture is the most effective method to control life-threatening bleeding and reduce late complication. In this study, we compared the effect of the non-invasive pelvic belt on various positions, and studied the effects of weight bearing and shifting during walking on pelvic belt position. Case 1) separation of symphysis pubis; Case 2) fracture of the superior and inferior ramus of the right pubis; Case 3) fractures of the superior and inferior ramus of both pubis and separation of symphysis pubis. Pelvic belt was prescribed in all three cases. Pelvic belt reduction reduced the distance between fracture line by 40~60% at all levels. Therefore, pelvic belt reduction is recommended as a non-invasive, safe and effective rehabilitative treatment for pelvic bone fracture patients to restore function without pain or secondary injury.

Factors Affecting Hemodynamic Instability in Patients with Pelvic Bone Fracture

PURPOSE: Treatment and prognosis in patients with pelvic bone fracture depend on the characteristics of the fracture and the stability of the pelvic ring. The purpose of this study is to analyze the characteristics of and the relationships between fracture patterns, injury mechanisms, clinical courses, and prognoses according to the hemodynamic pattern. METHODS: Between January 2004 and September 2006, 89 patients under diagnosis of pelvic bone fracture were retrospectively analyzed on the basis of medical records and radiologic examinations. Patients with confirmed hemorragic shock with a systolic pressure of less than 90 mmHg were defined as the shock group. Young's classification was used to characterize fracture patterns. Factors relating to the clinical manifestation and to treatments such as transfusion and surgery were analytically compared. RESULTS: The mean age of the patients was 48.8+/-18.7, among which 49 (55.1%) were male. The numbers of shock and non-shock patients were 35 (39.3%) and 54 (60.7%) respectively. Eighteen (51.4%) of the shock patient had injuries resulting from pedestrian accidents (p=0.008). According to Young's classification, lateral impact fractures amounted to 20 and 33, front-rear impact fractures to 9 and 20, and multiple fractures to 6 and 1 among the shock and non-shock patients, respectively (p=0.027). Thirty-nine (39) cases in non-shock injuries were conservatively managed while 18 cases in shock injuries were surgically treated. In the shock group, the liver and the kidney were often damaged, as well. Among the shock patients, the average admission period was 7.5+/-8.7 days in intensive care and 55.1+/-47.9 days in total, which were longer than the corresponding numbers of days for the non-shock patients (p<0.05). No deaths occurred in the non-shock group while 5 deaths (14.2%) occurred in the shock group (p=0.007). CONCLUSION: The factors affecting hemodynamic instability in patients with pelvic bone fracture are injury mechanism, classification of fracture, and associated injuries.

Complete Rupture of Sciatic Nerve by Protruded Kuncher Nail in Pelvic Bone Fracture: A Case Report

Rupture of sciatic nerve is a rare injury in minimally displaced pelvic bone fracture. We report one case of complete rupture of sciatic nerve that were resulted from the extremely protruded Kuncher nail inserted before accident and the preexisting heterotopic ossification with a review of the relevant literature.

Early Results of Percutaneous Ilioscral Screw Fixation in Unstable Posterior Pelvic Ring Injury / 대한정형외과학회잡지

In the past two decades, open reduction and internal fixation has been the preferred treatment of posterior pelvic ring disruption with instability. Despite of rigid fixation, it can induce bleeding, wound infection, wound necrosis and prolong operation time in the patient with combined injuries. To compensate for these disadvantages, we have implemented closed reduction and percutaneous iliosacral fixation under fluoroscopy in reducible posterior pelvic ring disruption. In spite of anatomical risk during screw insertion, the percutaneous iliosacral screw technique after closed reduction of the posterior pelvic ring disruption minimally violates the soft tissue envelope and reduces both the operative blood loss and infection rate. We are reporting the early results of our 6 patients treated between Aug. 1995 to Aug. 1996. The operation time was shorter than open reduction and internal fixation. There was no significant bleeding, wound infection and nerve injury by screws.

Relationship of the patterns of pelvic bone fracture and bladder rupture / 대한비뇨기과학회지

A clinical observation was made on 64 cases of the bladder rupture who were admitted to our hospital during the period from June, 1979 to February, 1991. The results are as following ; 1. Of 355 cases of the genitourinary tract injury, the bladder rupture were 64 cases (18.0%), which were composed of 40 cases (62.5%) of bladder rupture without pelvic bone fracture and 24 cases (37.5%) of bladder rupture with pelvic bone fracture. The bladder rupture without pelvic bone fracture were composed of 35 cases (87.5%) with intraperitoneal bladder rupture and 5 cases (12.5%) with extraperitoneal bladder rupture, the bladder rupture with pelvic bone fracture were composed of 13 cases (12.5%) with intra and extraperitoneal bladder rupture. 2. In 24 patients with pelvic bone fracture, the most common site of bladder ruptures were found on the lateral wall in 12 cases (50%), and followed by the dome in 9 cases (37.5%), multiple areas in 3 cases (12.5%). In 40 patients without pelvic bone fracture, the most common site of bladder ruptures were found on the dome in 33 cases (82.5%), and followed by the multiple areas in 4 cases (10%), lateral wall in 3 cases (7.5%). 3. The average size of the bladder rupture was 6.5cm in cases without pelvic bone fracture, 6. 8cm in cases with pelvic bone fracture, especially comminuted pelvic ring fracture had most severed bladder rupture (average; 8.3cm). 4. Of 24 pelvic bone fractures, pubic rami fractures were most common (41.6%), and followed by comminuted pelvic ring fracture (25%), anterior and posterior pelvic ring fractures (12.5%), acetabulum and isolated fractures (8.3%), symphyseal separation fractures (4.1%) in order of frequency. 5. 5 cases (20%) of pelvic bone fractures were associated with posterior urethral injury, especially 60% in The pubic rami fracture. There was no significant relation between the type of pelvic fracture and the type of bladder rupture, but the fractures involving pubic arch were more often associated with posterior urethral injury.

A Clinical Study of the Unstable Pelvic Bone Fracture / 대한정형외과학회잡지

The pelvis is a ring structure with strong ligamentous support. This support includes the symphysis pubis, the anterior and posterior sacroiliac ligaments, and the strong sacrospinous and sacrotuberous ligaments. Since the pelvis is a ring, disruption of any portion of the ring is always associated with disruption in another portion of the ring. Massive pelvic disruption is an important and often life threathening. The author reviewed 36 cases of unstable pelvic bone fractures treated at the Orthopedic department of Chonbuk National University Hospital from January 1982 to December 1989, and analized the causes of injury, types of fracture by Pennal and Tiles method, associated injuries, early and late complication, methods of treatment. The clinical results were obtained as follows: 1. The incidence of injury in male was almost same in female and most of the patients were in the 3rd to 5th decade of their life. 2. The causes of injuries were traffic accidents, fall-down, others. 3. The most common fractures of unstable pelvic bone fractures were type II fractures due to lateral compression and Type III fractures due to vertical shear(Br Penall and Tile). 4. The fractures of acetabulum and tibia and fibula were the most commonly associated bone and joint injuries. Also the injury on the genitourinary tract was the most commonly associated soft tissue injuries. 5. There are various mathods of treatment in unstable pelvic bone fracture. A satisfactory results of conservative treatment were 73% and operative treatment were 85%. 6. In unstable pelvic bone fractures we consider that the external fixstior should probably be the first choice of treatment.

Lower Urinary Tract Injuries Associated with Fractured Pelvis / 대한비뇨기과학회지

We reviewed 241 consecutive cases of pelvic fractures at the lnje Medical College Paik Hospital in Seoul during the period of 5 years from Jan., l98l to Dec., l985 to establish the relationship between the lower urinary tract injury and fractured pelvis. Of 241 patients with pelvic fractures 44(l8.3%) had lower urinary tract injury. The results were as follows: l. The pelvic fractures occurred most commonly in traffic accident as 62.7% and the age group ranging from 20 to 39 years old was 55.2% of patients with pelvic fracture. 2. Of 273 pelvic fractures in 241 patients unilateral pelvic rami fractures were 47.2%, bilateral pubic rami fractures were 23.1%, acetabular fractures, and Malgaigne fractures in orders of frequency. 3. The most common cause of lower urinary tract injuries associated with pelvic fractures was traffic accident (70.5%), and followed by direct blow, and fall-down in orders. 4. From the view of fracture patterns the lower urinary tract injuries associated with pelvic fractures occurred most commonly in unilateral pubic rami fractures (47.7%), and the ratio of lower urinary tract injuries following fracture patterns were 29.4% of Malgaigne fractures, 23.8% of bilateral pubic rami fractures, and 16.3% of unilateral pubic rami fractures. 5. Of 44 lower urinary tract injuries the urethra alone were injured in 63.6%, the bladder alone in 27.3%, and the bladder and urethra both in 9.1% of the cases. 6. All patients of lower urinary tract injuries associated with pelvic fractures had hematuria, either gross or microscopic, and 97.7% of these cases had gross hematuria.

A Clinical Observation of Urethral Injury / 대한비뇨기과학회지

A clinical observation was made on the injuries of urethra of the in-patient at Department of Urology, Chosun University Hospital during the period from February, 1972 to August, 1981. The results were as follows: 1. Of all 1142 cases hospitalized, 75 cases were injury of urethra, giving a rate of 6.6%. 2. The most prevalent group ranged from 21 to 30 years (22.7%). The sex ratio, male to female was 11.5:1. 3. The most frequently involved site was anterior urethra (46.7%)and the others were the posterior urethra (46.3%)and female urethra (8.0%). 4. The most common cause of urethral injury was traffic accident (48.0%)and followed by falling and straddle injury (38.7%), kick and blow (8.0%)etc. 5. Among 75 cases of urethral injury, the pubic bone fracture was associated in 33 cases (44.0%). 6. The incidence of impotence was higher in the case of posterior urethral injury. 7. Of the 49 cases of urethroplasty, anterior urethroplasty was performed in 16 cases, of which a primary realignment procedure was conducted in 8 cases, a perineal urethroplasty in 7 cases and a primary closure in one case Of the 49 cases of urethroplasty, posterior urethroplasty was performed in 30 cases, of which a primary realignment procedure was conducted in 22 cases, a perineal urethroplasty in 4 cases, a Badenoch's pull through urethroplasty in 3 cases after long-term suprapubic cystostomy and a transpubic urethroplasty in one case after long-term suprapubic cystostomy. Female urethroplasty was performed in 3 cases, of which 2 cases underwent a vaginal closure and one case a primary closure. 8. The complications of anterior urethral injury were urethral stricture (5 cases), urinary fistula (4 cases), impotence (1 case)and urethral diverticulum (1 case). The complications of posterior urethral injury were impotence (15 cases), urethral stricture (12 cases)urethral diverticulum (2 cases), urinary fistula (1 case)and incontinence (1 case). The complication of female urethral injury was incontinence in 2 cases.

The Treatment of the Pelvic Bone Fractures by Means of Hoffmann's External Skeletal Fixation Devices / 대한정형외과학회잡지

We have exprierienced 10 cases of pelvic bone fractures that were treated by Hoffmann's external fixation devices from June, 1979 to June, 1982. As a result, following advantages were noted; 1. Rapid recuction of pain, prevention of serious early complication, and easiness of nursing care were possible. 2. Late complications such as lumbosacral pain and gait disturbance could be preventable in majority of the patients, as well as shortening the duration of the hospitalization.

Lower Urinary Tract Injuries Associated with Pelvic Bone Fractures / 대한비뇨기과학회지

A clinical study was made on 108 patients with pelvic bone fractures and 37 patients with lower urinary tract injury in the Capital Armed Forces General Hospital during the period of 3 years from January, 1978 to December, 1980. Emphasis was placed on the mechanism of the bladder and urethral injuries. The results were summarized as follows: 1. The most common cause of pelvic bone fractures was traffic accident (88.0%). 2. 37 cases (34.3%) of the pelvic bone fractures were associated with lower urinary tract injuries. These included 17 ruptures of the urethra, 14 bladder injury and 6 bladder and urethral injuries. 3. Among the total bladder injuries (20 cases), we found 14 extraperitoneal ruptures of the bladder. 4 intraperitoneal ruptures and 2 bladder contusion. 4. Among the 23 urethral injuries, membranous urethral injuries were prominent, 19 membranous urethral ruptures and 4 bulbous urethral ruptures.

A Clinical Study of Lower Urinary Tract Injury Associated with Pelvic Bone Fracture / 대한비뇨기과학회지

A clinical study was made on 81 patients with pelvic fracture and 17 patients with lower urinary tract injury in the Hanyang University Hospital during the period of three years from May. 1972 to May, 1975. The results were as follows ; I) The most common cause of pelvic fracture was traffic accident (73%), and the age group ranging from 21 to 40 years old was 54% of patients with pelvic fractures. 2) On pelvic fractures, unilateral pelvic rami fractures were most common(44%), followed by bilateral pelvic rami fractures(25%), in order of frequency. 3) Fourteen cases( 17%) of the pelvic fractures were associated with lower urinary tract injury. 4) Thirty one cases(45%) of the lower urinary injuries were associated with pelvic fracture.