Management of a Complex Open Pelvic Injury: A Coordinated Team Approach

A man in his forties was brought to the Penn State Hershey Medical Center trauma unit. The patient sustained an open pelvic fracture, as well as an irreducible hip dislocation; he had a significant injury to his lower intestinal tract and massive soft tissue loss.

“Open pelvic fractures have a mortality rate of 50 percent. If you combine this with the spectrum of additional injuries this patient presented with, that number is probably closer to 75 percent,” says Henry Boateng, M.D., an orthopaedic trauma surgeon with Penn State Hershey Bone and Joint Institute. A team of trauma, colorectal, orthopaedic, and plastic surgeons joined together to improve the odds for this patient. “For cases like this, we take a very aggressive approach, and prioritize the treatments needed. The goal in the early stages is to prevent infection and provide stability,” explains Boateng. The abdomen was emergently addressed, the hip was emergently reduced, and the pelvis was then stabilized.

X-ray on day of injury

1: X-ray on day of injury.

2: Final soft tissue envelope prior to coverage.

2: Final soft tissue envelope prior to coverage.

3: X-ray of final coverage reduced and stable pelvis prior to flap coverage.

3: X-ray of final coverage reduced and stable pelvis prior to flap coverage.

4: Harvested lower extremity.

4: Harvested lower extremity.

5: Filet flap pelvis, lower extremity harvested to cover pelvis.

5: Filet flap pelvis, lower extremity harvested to cover pelvis.

The patient was maintained in an induced coma; a colorectal surgeon achieved closure of the gastrointestinal tract and established a colostomy. “Once the risk of infection from the colon and rectum were eliminated, we turned our attention towards stability of the pelvis and closure of the massive open wound,” says Boateng. These were among the first in a long series of back-to-back operations planned for this patient.

“This patient went to the operating room daily, undergoing serial debridement to stay ahead of infection. To perform bedside debridement for a wound of this magnitude places the patient at a high risk of infection,” says Boateng.

The more aggressive approach taken at Penn State Hershey Medical Center has met with success for other extreme trauma patients.

“In the very recent past, we’ve treated two other patients with open pelvic injuries, both from high-speed motorcycle accidents. Both survived with a team-based approach to resuscitation and back-to-back reconstructive operations. We’re working hard for this third patient to give him the best functional outcome possible,” says Boateng.

The patient has undergone additional surgeries, aimed at finally achieving a clean, stable, and covered pelvis. Boateng explains, “Coverage of this wound was incredibly complex. It required significant mobilization and harvesting of most of the tissue in one leg to cover the entire pelvis and allow the patient to have function and potential mobility. We were successful in achieving a viable and clean soft tissue envelope with a stable pelvis.”

Henry Boateng, M.D.Henry Boateng, M.D.
Assistant Professor, Orthopaedics and Rehabilitation
Orthopaedic Trauma Surgeon
Phone: 717-531-1363
Fellowship: Orthopaedic trauma, Brigham and Women’s Hospital, Boston, Massachusetts
Residency: Orthopaedic surgery, Johns Hopkins Hospital, Baltimore, Maryland
Medical School: Georgetown University School of Medicine, Washington, D.C.

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