Abstract
A previously healthy 49-year-old male builder was injured by a 1.5 ton steel plate that accidentally fell on this patient. He was immediately transferred to our facility in a state of shock. With the diagnosis of unstable pelvic fracture and extra-peritoneal rectal perforation, the former was managed by massive transfusion, TAE, and external pelvic fixation and the latter by rectal transection, rectal washout, and presacral drainage. After the initial stabilization in the ICU, a diverting colostomy was created on the following day. After 20 days of intensive care with rigorous local wound irrigation and debridement, the patient recovered from sepsis. Due to the severe peripelvic infection, the external fixator failed to maintain the stability of the fractured pelvis ; however, with daily wound care under the adequate provision of analgesics, the pelvis became gradually stabilized over the next 4 months. Rehabilitation enabled the patient to be discharged home 10 months after the injury.
In this case, the management of unstable pelvic fracture became even more complicated with concomitant rectal injury. We herein report our successful treatment of this case, and we review the literature regarding methods to stabilize a fractured pelvis in the face of peripelvic soft tissue infection.
