Hemipelvectomy, a lifesaving operation in severe open pelvic injury in childhood

Abstract

Near-complete traumatic hemipelvectomy probably carries an extremely high mortality rate. The usual techniques which have been used to control major hemorrhage associated with pelvic fractures such as transperitoneal vascular ligation, intra-arterial embolization, and packing are not applicable (14). Successful management requires prompt recognition of the nature of this injury so that surgical efforts may be directed at resuscitation and expeditious operative completion of the traumatic amputation. When this decision is made appropriately, the dual goals of control of hemorrhage and prevention of sepsis can be achieved. We report the management of a 7-year-old boy who sustained this injury after being struck by a tractor-trailer. In spite of massive resuscitation, hemorrhage could not be controlled and the child remained in shock. When it was recognized that he had sustained an incomplete traumatic left hemipelvectomy, it was surgically completed, permitting prompt control of the hemorrhage and restoration of hemodynamic stability. Intestinal and urinary diversion allowed an uneventful postoperative recovery without significant infection. Although hemipelvectomy appears to be a radical procedure in children with major pelvic injuries, it may be lifesaving and should therefore be considered in those with severe unilateral pelvic injury and uncontrollable hemorrhage. The potential for physical rehabilitation in the group of young, mostly male patients who have survived this injury appears to be unexpectedly good.