(Disclaimer: This article is for general science purposes only. To protect Mr. Li’s privacy, the relevant information in the following content has been processed)
Abstract: Pelvic fracture is a more serious type of fracture in clinical practice, and untimely treatment may cause hemorrhagic shock and even endanger life. The patient in this case is a 42-year-old Mr. Li, who suffered a pelvic fracture due to vehicle impact extrusion, but showed signs of traumatic hemorrhagic shock after the injury. After emergency blood transfusion + medication, and late fracture internal fixation surgery, Mr. Li eventually healed the fracture and basically recovered the lower limb walking function.
Basic information】Male, 42 years old
Disease Type】Pelvic fracture, traumatic hemorrhagic shock
Hospital】The First Hospital of Harbin Medical University
Date of Consultation】November 2021
Treatment plan】Surgical treatment (fracture incision and internal fixation) + drug treatment (0.9% sodium chloride solution, polymineral peptide injection) + blood transfusion treatment
Treatment period】20 days of inpatient treatment and regular outpatient follow-up
Treatment effect】Fracture healing, walking back to normal
I. Initial consultation
Mr. Li was injured by the rear-end car in a rear-end accident, and immediately after the injury, he developed swelling, pain and inability to walk in the pelvic area. After being sent to the emergency room by 120 emergency, further examination revealed that although he was still conscious and could answer questions normally, his face was pale, the skin temperature of his limbs was low, his hands and feet were wet and cold, his blood pressure was 90/60 mmHg, his heart rate was 120 beats/min, his pelvic area was obviously swollen, his local pressure was painful, his pelvic crush and separation test was positive, and his X-ray showed that Mr. Li had multiple pelvic fractures with obvious displacement of the fracture ends. The final diagnosis of pelvic fracture with traumatic hemorrhagic shock was confirmed.
II. Treatment process
Mr. Li’s condition was critical and he was immediately transferred to ICU, where blood pressure, heart rate, blood oxygen and other vital indicators were continuously monitored and comprehensive anti-shock treatment was given. Emergency blood was collected and the red blood cells were 68g/L, which indicated the presence of severe blood loss. Immediate transfusion of 0.9% sodium chloride solution with polygelatin peptide injection to expand the volume, along with blood transfusion therapy to replenish blood volume, and temporary fixation of the pelvic region using pelvic straps. CT of the pelvis and 3D reconstruction were completed to clarify the fracture pattern, and CT and ultrasound of the abdomen and pelvic organs were completed to exclude concomitant injuries. Mr. Li was transferred to the Department of Orthopaedics on the 3rd day after admission, and received surgery for internal fixation of the fracture on the 7th day after admission.
III. Treatment effect
After active treatment, Mr. Li was clearly conscious and felt better mentally when he was transferred out of ICU, his red blood cells rebounded to 100g/L, blood pressure recovered to 115/80mmHg, and heart rate decreased to 92 beats/min. There was no abnormal manifestation of infection and necrosis in the incision after fracture surgery, and the surgical incision healed smoothly after 2 weeks. At the time of discharge, Mr. Li’s lower limb strength and hip movement were basically normal. At the follow-up visit 3 months after the surgery, he could go down to the ground properly, and at the follow-up visit 6 months after the surgery, the walking function basically returned to normal.
IV. Notes
We are glad that Mr. Li finally recovered from his condition, but we still need to remind that although he can walk on the ground after the initial healing of the pelvic fracture, he needs to pay attention to avoid walking for a long time or walking with weight, and pay attention to active flexion and extension exercises of the lower limb joints and muscle contraction exercises to prevent the formation of deep vein thrombosis in the lower limbs. In terms of diet, pay attention to strengthen the intake of calcium and protein to promote fracture healing. After the fracture heals, the internal fixation can be kept in the body and does not need to be removed.
V. Personal insight
A pelvic fracture is a serious fracture and should be treated as soon as possible after the injury. As in the case of Mr. Li, the symptoms of traumatic hemorrhagic shock appeared after arriving at the hospital, and he turned to safety through a series of emergency treatment. A fracture in this case cannot be operated on rashly, otherwise it will cause severe bleeding that is difficult to control. Pelvic band can reduce the pelvic volume and indirectly control the bleeding, which is often used in the emergency treatment of pelvic fracture. Mr. Li was treated promptly and effectively, and eventually obtained a satisfactory treatment result.