title: Open pelvic ring fracture and multiple fractures of the lower extremities: a case report.
abstract: A 73-year-old female was hit by a car, and transferred to our hospital. On examination, her consciousness was alert, but her vital signs were unstable. There are three 10-cm open wounds on her right buttock. X-rays showed an unstable pelvic ring fracture, a right femoral shaft, a right proximal tibia and a right tibial plafond fractures. One hour after the injury, transarterial embolization (TAE) followed by external fixation (EF), and retroperitoneal pelvic packing (RPP) was performed. Two days and five days after the injury, thorough debridement of the open wounds was performed. The skin defect on the right buttock and the lower abdomen had enlarged to 40 x 35 cm, therefore, negative pressure wound therapy was applied. On the same day, right femur was fixed using a retrograde intramedullary nailing. 12 days after the injury, the proximal tibial fracture was fixed using a plate, and the tibial plafond fracture was fixed using screws and external fixators. 28 days after the injury, the split-thickness skin graft was performed on the right buttock and the lower abdomen. Seven months after the injury, the open wounds were completely healed without infection. She was able to walk smoothly with a T-cane. For the management of open pelvic ring fractures, it is essential to perform TAE, EF and RPP as soon as possible. Providing aggressive management, including thorough debridement, is mandatory to prevent severe infection and sepsis. We achieved a good clinical outcome by using a combination of TAE, EF, RPP and staged surgery, including thorough debridement.
authors.forename: Naohide
authors.initials: N
authors.lastname: Takeuchi
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Masumoto
authors.forename: Junichi
authors.initials: J
authors.lastname: Nojiri
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Akiho
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Hotokezaka
authors.forename: Kosuke
authors.initials: K
authors.lastname: Sasaki
authors.forename: Kenichi
authors.initials: K
authors.lastname: Kawaguchi
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Tsukamoto
authors.forename: Kenta
authors.initials: K
authors.lastname: Momii
authors.forename: Naohiro
authors.initials: N
authors.lastname: Fujita
authors.forename: Takao
authors.initials: T
authors.lastname: Mae
mesh_terms: D000063:Accidents, Traffic; D000368:Aged; D004621:Embolization, Therapeutic; D005260:Female; D005592:Fracture Fixation / Q000379:methods*; D005597:Fractures, Open / Q000601:surgery* / Q000628:therapy*; D006801:Humans; D007869:Leg Injuries / Q000601:surgery; D010388:Pelvis / Q000293:injuries*