Delayed traumatic hemipelvectomy after crush injury in a pediatric patient: a case report.

INTRODUCTION: Traumatic hemipelvectomy is a rare operation, often performed for injuries caused by a high force mechanism such as a traffic or industrial accident, and often fatal. Most often performed emergently, here we report a traumatic hemipelvectomy performed on a pediatric patient one month from initial injury.

CASE PRESENTATION: A 7-year-old healthy male was crushed between two motor vehicles while riding his bicycle. He was taken emergently to the nearest trauma center and underwent external fixation of his pelvis, exploratory laparotomy, abdominal packing, diverting colostomy, vesicostomy, and placement of an intra-arterial left iliac to femoral shunt. He was then transferred to our facility for further management. Following stabilization for severe hemorrhagic shock, his shunt was converted to an iliofemoral bypass. Despite good vascular in-flow and aggressive debridement of his left lower extremity, he continued to have ongoing muscle and pelvic necrosis and a persistent SIRS response. He subsequently underwent left hemipelvectomy approximately one month from time of initial injury. He then steadily recovered and was ultimately discharged to acute inpatient rehabilitation.

CONCLUSION: We describe an unusual case of delayed pediatric traumatic hemipelvectomy. The patient not only survived the initial devastating injury but also received timely revascularization. The patient ultimately required hemipelvectomy despite a stepwise, multidisciplinary approach to limb salvage.