Long-term physical and psychological outcome following traumatic hemipelvectomy.

PURPOSE: First time examination of the physical and psychological long-term outcome following traumatic hemipelvectomy. METHODOLOGY: In this study, all patients suffering from traumatic hemipelvectomy that were treated in a level-A trauma center since 1988 were retrospectively evaluated. The authors aimed to compare the physical and psychological outcome following primary amputation (A) vs. limb-preservation (LP) procedures. The patients were examined with a focus on pain, function, mobility and general health. As part of this examination, various scores were recorded, i.e., Majeed Score, Time up & Go or SF-36. RESULTS: The following work showed 13 patients who had suffered a traumatic hemipelvectomy, 8 of whom survived. Five of these were available for subsequent clinical re-examination; of these, three patients underwent an amputation, while limb preservation was performed on two patients. Mean follow-up of the amputee group was after 12 years compared to 6.5 years following limb preservation. After limb preservation, both patients reported phantom limb pain at the affected leg, despite pain medication. The general state of health was assessed as 82/100 (A) and 45/100 (LP). The Majeed score was 61 (A) vs. 45 (LP). In the clinical examination, three out of five patients (2 LP, 1 A) showed peroneal palsy (PP). In the quality-of-life analysis based on the SF12/36 and the NHP, amputees scored higher than the patients who underwent limb preservation surgery. CONCLUSION: In our small patient cohort, satisfaction, pain and mobility tend to be better following primary amputation compared to limb preserving surgery.

Three-year follow-up of a Traumatic Hemipelvectomy Survivor: A Case Report.

The management of a patient with traumatic hemipelvectomy is complex. We report the acute management and rehabilitation of a 21-year-old patient as well as her prosthesis modification. She was able to return to society as a K3 level ambulator.

Reconstruction of the pelvis after traumatically induced bilateral partial hemipelvectomy: a case report.

BACKGROUND: Traumatic hemipelvectomy is a catastrophic fracture of the pelvis as a result of high-energy trauma, such as in a car accident. There have been few case reports of traumatic hemipelvectomy because many of these patients die before they are transferred to a hospital. However, an increasing number of patients are being saved and admitted to hospital due to improvements in resuscitation and the emergency response system. Accordingly, there has been a growing body of reports on the management and reconstruction of traumatic hemipelvectomy. CASE PRESENTATION: A healthy 20-year-old Japanese man was trapped beneath a 3-ton steel frame while working on a crane. We describe here a very challenging case of traumatically induced bilateral partial hemipelvectomy with successful reconstruction of our patient's pelvis using a unilateral anterolateral thigh flap. CONCLUSION: To the best of our knowledge, there have been few reports of bilateral hemipelvectomy and our case is the first to be successfully treated with a unilateral anterolateral thigh flap.

First successful complete replantation of a traumatic hemipelvectomy: follow-up after 30 months.

Traumatic hemipelvectomy is a severe, however rare injury associated with high lethality. Up to now, immediate surgical completion of the amputation has been recommended as a lifesaving therapy. We present a case of near complete hemipelvectomy with open fracture of the ileosacral joint, wide open symphysis and severe soft tissue trauma including a decollement around the pelvis. Successful complete replantation was performed by primary internal stabilisation and revascularisation using vascular grafts. In the further hospital course, numerous revisions of the soft tissue injury and reconstructive surgery were needed. Thirty months later, the patient's condition is physically and psychologically stable and he is able to walk using crutches. The key point of successful management was skilled emergency damage control surgery followed by dedicated surgical care to avoid septic complications.