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PELVIC FRACTURE
Trauma & Orthopaedics Urology

PELVIC FRACTURE

 

   

 

Mr AI 42 , galamasey  miner

  • Pc : laceration to groins : 12hrs prior to presentation
  • Fan belt tore off the machine in operation leading to groin and perineal injuries , immediately couldn’t walk, carried to nearly hospital where ivf, analgesics, encircling pelvic and thigh compressive dressing applied and referred
  • Loc – no (head ,neck ,chest pains ) fever -, severe pain bleeding from sites of laceration at time of injury
  • Not able to pass urine
  • Stools nil
  • Pmhx nil
  • Dhx prescribed

 

  • Examination :
  • Afebrile , pale , fully conscious and well oriented
  • Head n neck no tenderness, tpr pres in upper l, lower limbs not obj assessed
  • Chest CC, no tenderness , moved symm
  • Cvs : bp 139/82 mmHg , {Pulse 82 bpm , reg good v, spo2 96
  • Lower limb pulses preserved
  • Abd soft upper part , mocves with resp, no bruising over flanks, no renal angle ten
  • Dre : normal anal sphincter tone , no other abnormality

 

  • S/L: rt deep groin laceration 16cm , left 8cm ,left scrotal laceration.,perineal laceration , penile skin and dartos avulsion, pelvic comp tens pos
  • Visibly Distended urinary bladder, test asp ..clear urine, palpable fractured pubis
  • No blood at external urethral meatus

 

  • Diagnosis : Deep groin laceration/ AROU 2 pelvic fracture urethral disruption

 

  • Management summary
  • blood transfusion
  • Iv antib , tetanus prophylaxis, analgesic
  • Wound toileting , suturing
  • Urine diversion (  SPC )
  • Pelvic xr, cxr, RUG , MCUG later
  • EXTERNAL FIXATION

WOUND EXPLORATION 

  • Mild sedation
  • Wound irrigation with saline
  • Formal spc done
  • Transinguinal rt orchidectomy done
  • Extravesical space drained passively and wound closure done

 

  • external fixation done by orthopaedic team . Patient doing well.

Dr Richard Ametih ( Urology resident ), KATH

Dr Opuni( Orthpopaedic resident ), KATH

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