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Clinical Images  |   December 2014
Open Pelvic Fracture Due to Crush Injury
Author Affiliations & Notes
  • Quin Shepherd, OMS IV
    From the Des Moines University College of Osteopathic Medicine in Iowa and the Department of Medical Education at St Joseph's Health Center in Warren, Ohio (Student Doctor Shepherd), and the Department of Orthopaedic Trauma at St Elizabeth's Health Center in Youngstown, Ohio (Dr Schrickel).
  • Tyson T. Schrickel, MD
    From the Des Moines University College of Osteopathic Medicine in Iowa and the Department of Medical Education at St Joseph's Health Center in Warren, Ohio (Student Doctor Shepherd), and the Department of Orthopaedic Trauma at St Elizabeth's Health Center in Youngstown, Ohio (Dr Schrickel).
  •  *Address correspondence to Quin Shepherd, OMS IV, St Joseph Health Center, 667 Eastland Ave SE, Warren, OH 44484-4503. E-mail: quin.c.shepherd@ dmu.edu
     
Article Information
Emergency Medicine / Imaging / Clinical Images
Clinical Images   |   December 2014
Open Pelvic Fracture Due to Crush Injury
The Journal of the American Osteopathic Association, December 2014, Vol. 114, 936-937. doi:10.7556/jaoa.2014.182
The Journal of the American Osteopathic Association, December 2014, Vol. 114, 936-937. doi:10.7556/jaoa.2014.182
A 56-year-old man in hemorrhagic shock after being crushed at an industrial worksite had an open pelvic fracture involving the right sacrum and an unstable right hemipelvis (image A) as well as bilateral tibial fractures, a right femur fracture, and a nearly circumferential rectal laceration. The patient was placed in a pelvic binder and given cefazolin and gentamicin. Both internal iliac arteries were then embolized, and external fixation of the pelvis, exploratory laparotomy with diverting colostomy, and bilateral external fixation of the tibias were performed. Several days later, the patient underwent internal fixation of the anterior and posterior pelvis (image B). The patient continues to recover. 
Pelvic fractures account for 3% of skeletal injuries and are associated with severe trauma such as that caused by a car striking a pedestrian, a motor vehicle collision, or a fall from higher than 15 feet.1,2 Good outcomes have been reported in open fracture cases with early recognition and treatment, including control of acute hemorrhage, fracture stabilization, sepsis prevention, and early diverting colostomies when appropriate.3 A small percentage of pelvic fractures require embolization, but when performed early in the treatment course, it can be up to 100% effective.4 Mortality rates associated with open fractures have been reported to be between 5% and 58%.2,3 (doi:10.7556/jaoa.2014.182) 
References
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Cannada LK, Taylor RM, Reddix R, Mullis B, Moghadamian E, Erickson M. Southeastern Fracture Consortium. The Jones-Powell classification of open pelvic fractures: a multicenter study evaluating mortality rates. J Trauma Acute Care Surg. 2013; 74(3): 901-906. doi:10.1097/TA.0b013e3182827496. [CrossRef] [PubMed]
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