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- Preperitoneal pelvic packing as a salvage operation for postoperative retroperitoneal bleeding with hemodynamic instability after the Kocher-Langenbeck approach to the acetabulum: a case report
- Doo-Hun Kim, Maru Kim, Dae-Sang Lee, Tae Hwa Hong, Hangjoo Cho
- J Trauma Inj. 2025;38(3):285-289. Published online June 25, 2025
- DOI: https://doi.org/10.20408/jti.2024.0087
- 1,796 View
- 44 Download
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Abstract
PDF - Pelvic fractures result from high-energy trauma, and when accompanied by hemorrhagic shock, the mortality rate increases to 40%. Pelvic fractures are anatomically categorized as pelvic ring disruptions and acetabular fractures, each requiring different treatment methods and approaches. Acetabular fractures, which also result from high-energy injuries, may be accompanied by hemorrhagic shock. Treatment options for pelvic fractures with hemorrhagic shock include angioembolization, preperitoneal pelvic packing (PPP), and emergency laparotomy. In hemodynamically stable patients, early total care may be attempted, and for acetabular fractures (posterior column), the Kocher-Langenbeck approach is the treatment of choice. This case report describes the use of PPP as a salvage operation for postoperative retroperitoneal bleeding with hemodynamic instability following a Kocher-Langenbeck approach for an acetabular fracture with pelvic ring injury. The patient was discharged without postoperative complications such as bone displacement or surgical site infection. While PPP is commonly employed as an initial treatment modality for pelvic fractures with hemorrhagic shock, it may also be valuable in managing postoperative retroperitoneal bleeding with hemorrhagic shock.
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Summary
- Percutaneous screw fixation and external stabilization as definitive surgical intervention for a pelvic ring injury combined with an acetabular fracture in the acute phase of polytrauma in Korea: a case report
- Hohyoung Lee, Myung-Rae Cho, Suk-Kyoon Song, Euisun Yoon, Sungho Lee
- J Trauma Inj. 2023;36(3):298-303. Published online July 13, 2023
- DOI: https://doi.org/10.20408/jti.2023.0002
- 4,821 View
- 99 Download
- 1 Web of Science
- 1 Citations
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Abstract
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- Unstable pelvic ring injuries are potentially life-threatening and associated with high mortality and complication rates in polytrauma patients. The most common cause of death in patients with pelvic ring injuries is massive bleeding. With resuscitation, external fixation can be performed as a temporary stabilization procedure for hemostasis in unstable pelvic fractures. Internal fixation following temporary external fixation of the pelvic ring yields superior and more reliable stabilization. However, a time-consuming extended approach to open reduction and internal fixation of the pelvic ring is frequently precluded by an unacceptable physiologic condition and/or concomitant injuries in patients with multiple injuries. Conservative treatment may lead to pelvic ring deformity, which is associated with various functional disabilities such as limb length discrepancy, gait disturbance, and sitting intolerance. Therefore, if the patient is not expected to be suitable for additional surgery due to a poor expected physiologic condition, definitive external fixation in combination with various percutaneous screw fixations to restore the pelvic ring should be considered in the acute phase. Herein, we report a case of unstable pelvic ring injury successfully treated with definitive external fixation and percutaneous screw fixation in the acute phase in a severely injured polytrauma patient.
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Citations
Citations to this article as recorded by
- Advances in Managing Pelvic Fractures in Polytrauma: A Comprehensive Review
Uros Dabetic, Jovana Grupkovic, Slavisa Zagorac, Dejan Aleksandric, Nikola Bogosavljevic, Goran Tulic
Journal of Clinical Medicine.2025; 14(5): 1492. CrossRef
TOP- External iliac artery injury with posterior pelvic ring injury in Korea: a report of two cases
- Joosuk Ahn, Ji Wan Kim
- J Trauma Inj. 2023;36(2):137-141. Published online December 1, 2022
- DOI: https://doi.org/10.20408/jti.2022.0046
- 4,354 View
- 83 Download
- 1 Web of Science
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Abstract
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- Pelvic ring injuries associated with external iliac artery injuries are rare and may be life-threatening condition. The most important factors in the managements are the immediate bleeding control and restoration of distal blood flow. We report two cases of pelvic ring injuries with external artery injuries. One case was occlusion of external iliac artery with concomitant rupture of internal iliac artery. The other case was ruptured external iliac artery. Every surgeon must understand the possibility of hidden lesions—for example, arterial rupture and thrombus—and should consider the need for embolization or thrombectomy when treating this type of injury.
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Summary
- Delayed bladder perforation due to screw loosening after pelvic ring injury surgery: a case report
- Hyun-Chul Shon, Ho-Won Kang, Eic-Ju Lim, Jae-Young Yang
- J Trauma Inj. 2022;35(1):51-55. Published online December 22, 2021
- DOI: https://doi.org/10.20408/jti.2021.0054
- 5,558 View
- 110 Download
- 1 Web of Science
- 3 Citations
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Abstract
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- Pelvic ring injuries have high mortality and morbidity rates, and they are difficult to treat because accompanying injuries to the pelvic organs, genitourinary organs, and neurovascular tissues are common. Genitourinary injuries are common comorbid injuries that have been reported to occur in 5% to 6% of all pelvic ring injuries. However, these injuries usually occur simultaneously with the pelvic ring injury, whereas relatively little research has dealt with genitourinary injuries that occur after treatment of a pelvic ring injury. To the best of our knowledge, only three cases of delayed bladder perforation due to screw loosening after symphyseal plate fixation in anterior pelvic ring injury have been reported worldwide, and no such cases have yet been reported in Korea. Since the authors experienced this very rare complication after pelvic ring surgery, we report this case along with a literature review.
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Summary
Citations
Citations to this article as recorded by- Delayed migration of orthopedic screw into the bladder following pelvic fracture fixation
Carly R. Ulrich, Barry A. Ndeh, Ryan H. Fitzwater, Jessica L. Sop, Nancy M. Duvall, Aaron L. Sop
Trauma & Case Reports.2026; 61: 101298. CrossRef - Delayed Bladder Perforation Resulting From Large Bladder Stone and Gluteal Abscess Caused by Pelvic Plate Loosening: A Case Report
Shun-An Kan, Ya-Che Lee, Hui-Chu Tsai, Ying-Ying Su, Fang-Chieh Lien
Cureus.2024;[Epub] CrossRef - Postoperative extraperitoneal bladder injury after metal pelvic osteosynthesis for pelvic injury
Khalid Abdullahi, Obadele Olusegun George, Ajiboye Lukman Olalekan, Abubakar Isiyaku, Muhammad Abubakar Sadiq, Aljannare Bashir Garba, Okezie Chukwuebuka Kingsley, Agwu Ngwobia Peter
Academia Medicine.2024;[Epub] CrossRef
- Simultaneous Surgery on Jejunum perforation with Pelvic Ring Fracture: A Case Report
- Hoejeong Chung, Keum Seok Bae, Seong Yup Kim, Doosup Kim
- J Trauma Inj. 2016;29(2):56-59. Published online June 30, 2016
- DOI: https://doi.org/10.20408/jti.2016.29.2.56
- 2,772 View
- 17 Download
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Abstract
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- Patients with pelvic bone fractures with gastrointestinal perforations are reported in 4.4% of the cases and in very rare cases jejunum (0.15) is involved. However, intestinal perforations are often undiagnosed on the first examination before peritonitis is evident. We are presenting a report where a patient with anteroposterior compression injury, who was expected to undergo an internal fixation procedure, did not show any jejunum perforations on abdominal CT or other physical exams but was found on abdominal CT 1 week after right before surgery, therefore excision and anastomosis surgery, pelvic open reduction and internal fixation was simultaneously done with favorable results. In our case, we present a 61 year old male patient with liver trauma, adhesion at the abdominal cavity, with a past history of gallbladder excision, but without abdominal pain, fever, or infection symptoms. Therefore, this was a case that was difficult to initially diagnose the patient with jejunum perforation and peritonitis. The diagnosis was further supported during laparotomy when peritonitis around the area of intestinal perforation was observed. Generally, it is understood that pelvic bone fracture surgery is not immediately done on patients with peritonitis. However, this kind of patient who had peritonitis with intestinal adhesion and other complications could undergo surgery immediately as infection or other related symptoms did not coexist and the patient was rather stable, and as a result the treatment was successful.
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