The Adventure of Living in the Kingdom of God

Tuesday, March 5, 2013

Kenya: Pelvis & Acetabular Frxs

Few fractures are shipped to experts more quickly than the mention of a pelvic ring or acetabular (hip socket) fracture. They are among the most complex fractures seen by an orthopedic surgeon and are typically the result of high energy trauma - car wrecks, motorcycles, jumping off of a high structure, etc. In the US, people who treat acetabular fractures and pelvic ring injuries surgically are traumatologists - orthopedic surgeons who after residency spent at least a year specializing in complex fracture care including these fractures. Kenya, however, does not have traumatologists. They have orthopedic surgeons (if they're lucky) who do not have the luxury to specialize into only treating one part of the body. If they don't fix the fracture, no one will. Tenwek is blessed to have two wonderful orthopedic surgeons who both wind up taking care of whatever comes through the door - 'whatever' can be alot of different things! While I was there at Tenwek, we had a run of several pelvic ring injuries and acetabular fractures that were fixed. Enjoy!

Case #1: 30 year old male s/p RTC with bilateral acetabular fractures. He presented with bilateral hip dislocations and had bilateral traction pins placed upon presentation.
Right Posterior Wall Acetabular Fracture. Hip was unstable with range of motion and required ORIF with 3.5 mm Recon Plate. Left comminuted posterior wall acetabular fracture with intraarticular fragments. Intraarticular fragments were removed and the hip was stable during range of motion. In the OR, we did the left side first in the lateral position with a peg board, closed him up, and then flipped him over and fixed the right side. (Sorry, no postop xrays)

Case #2: 27 year old female involved in a RTC. First went to government hospital and told to go to Tenwek. Arrived 48 hours after sustaining her injury.

Right Vertical Shear Sacroiliac Joint Disruption with Left Pubic Root Fracture and Pubic Symphysis Disruption.

Postop: S1 & S2 Trans-Sacral Trans-Iliac Percutaneous Screw Fixation. Decision was made not to fix front of pelvic ring because of the extent of surgical approach required to fix it.

Another Postop
 Case #3: 35 year old male who presented (on my first call night) with left hip dislocation. Hip was reduced but found to have intraarticular fragments and large Hill-Sachs lesion of femoral head. 

Left hip dislocation, Posterior Wall Acetabular Fracture

CT Scan: Left Posterior Wall Acetabular fracture, Intraarticular Fragment, Hill-Sachs lesion of Femoral Head
Postop: ORIF Left Posterior Wall Fracture, Removal of Intraarticular Fragments, 3.5 mm Recon Plate
Case #4: 29 year old male who sustained a Right Acetabular Fracture and Right Distal Radius/Ulna fracture in a ... you guessed it - road traffic crash!

Postop: Right Transverse Posterior Wall Acetabular Fracture. Percutaneous fixation attempted to reduce the articular stepoff along the posterior column. Posterior wall fragment was minimally displaced. Fracture did not compress well likely because surgery occurred nearly 3 weeks after the injury. Percutaneous fixation has been used at Tenwek a handful of times with good results if the fractures are fixed acutely.
More to come...

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