Traumatic pelvic fracture with rupture of the ovarian vein - A case report.

INTRODUCTION AND IMPORTANCE: Traumatic pelvic fractures are complex injuries often associated with significant morbidity and mortality. Among the complications of pelvic trauma, rupture of the ovarian vein represents a rare yet potentially life-threatening event. Prompt recognition and appropriate management are essential to mitigate the risk of hemorrhage and associated complications. CASE PRESENTATION: We present a case of a 70-year-old woman who sustained a traumatic pelvic fracture following a skiing accident, resulting in rupture of the left ovarian vein. The patient came with the ambulance in the emergency room with lower abdominal tenderness, pelvic pain, but no signs of hemorrhagic shock. Imaging studies confirmed the diagnosis of a pelvic fracture with venous leakage of the left ovarian vein. CLINICAL DISCUSSION: This review synthesizes recent insights into the diagnosis, management, and complications associated with pelvic fractures, with an emphasis on optimizing patient outcomes through a multidisciplinary approach. The analysis incorporates findings from key studies, including those by Wong and Bucknill, Ma Y et al., and Tullington and Blecker, which advocate for the use of advanced diagnostic tools like CT scans and systematic evaluation processes. These studies underline the necessity of precise classification systems such as the Tile classification to guide treatment and predict outcomes. CONCLUSION: Management of traumatic pelvic fractures with associated vascular injuries requires a multidisciplinary approach involving trauma surgeons, interventional radiologists, and critical care specialists. Early recognition, accurate diagnosis, and timely intervention are paramount in optimizing outcomes and reducing the risk of mortality. This case underscores the importance of prompt intervention and highlights the challenges associated with traumatic pelvic fractures and rupture of the ovarian vein. Further research is warranted to enhance our understanding of optimal management strategies and improve outcomes for patients with these complex injuries.

The impact of Covid-19 in proximal femur fractures. An observational study of the mortality rate.

BACKGROUND AND AIM: Fractures of the proximal femur in the elderly are probably the leading cause of death in the orthopedic patients. Furthermore, after the spread of the pandemic, the mortality rate in the elderly has certainly increased. The aim of our study is to evaluate whether the mortality following proximal femur fractures is affected by the concomitant pandemic. METHODS: We admitted to our study patients over 65 years old, who presented to our Emergency Room with a diagnosis of proximal femur fracture in the first quarter of the years 2019, the period before the development of the pandemic, of 2020 during the pandemic and of 2021 with the new wave of Covid-19. 2022 was not taken into consideration because the mortality data are not yet available and to have at least one year follow-up after surgery. All patients were divided by fracture's type and treatment; the time elapsed from trauma to surgery and from trauma to discharge was also evaluated. For each deceased patient, we considered the time elapsed from the operation to death and whether there was an episode of positivity to Covid-19 following the trauma and after discharge (all patients had a negative swab at the time of admission). CONCLUSIONS: Fractures of the proximal femur in the elderly patient are undoubtedly an important cause leading to the death. The spreading of the Covid-19 pandemic has allowed our department to reduce the gap between trauma and intervention time and from trauma to discharge which is undoubtedly a positive prognostic factor. However, the concurrence of a positivity from the virus does not seem to influence the mortality times following the fracture.

Five-years Control after a Delayed Diagnosis of a Traumatic Posterior Hip Dislocation in a 5 years Old Boy- A Case Report.

Introduction: Evaluation of pain in children after trauma can sometimes be difficult; in particular, a knee pain in a child could originate from the hip, until evidence of the contrary. Often is the low-energy trauma that leads to a joint dislocation in children. Furthermore, the present guidelines state that a hip dislocation in a child should be replaced within 6 (maximum 12) hours, to reduce the risk of avascular necrosis (AVN) of the femoral head. Case Presentation: After falling during sports activity at the kindergarten, a 5-years-old boy was taken to the emergency room of a small hospital with severe pain in his right knee. After the visit and the instrumental diagnosis, he was afterward discharged with the diagnosis of contusion of the thigh. After a week of pain and inability to load despite the analgesic therapy, he was accompanied to our hospital, from which the diagnosis of hip dislocation emerged and then reduced in short sedation. The next day he underwent to a magnetic resonance imaging (MRI) examination and pelvic-podalic cast immobilization. At the following check-ups, he had no more pain and the active ROM was complete. A long-term control after 5 years showed a complete and painless active ROM and the MRI showed a normal growth of the bone, without any sign of AVN of the femoral head. Conclusion: Despite the long waiting period and going against the guidelines, the child recovered his full daily and physical activity, without necrosis of the femoral head, growth disorder, or dysmetria in the lower limbs.