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Right lateral decubitus and perisplenic hematoma

trauma-list@trauma.org trauma-list@trauma.org
Fri, 3 Jan 2003 11:10:41 +1300 

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I can't see any reason not to do the appropriate popliteal surgery. I am not aware of any evidence that prone positioning will worsen a splenic injury. If the spleen is that precarious it should come out so that adequate treatment of the popliteal injury can occur

Ian Civil
Director of Trauma Services
Auckland Hospital
> 
> From: "Josep M. Muņoz Vives" <tmv@htrueta.scs.es>
> Date: 2003/01/03 Fri AM 06:05:57 GMT+13:00
> To: <trauma-list@trauma.org>
> Subject: Right lateral decubitus and perisplenic hematoma
> 
> Recently we received a 20 yo old patient that suffered a car crash.
> 
> GCS 14. Thorax OK. Abdominal pain, no abdominal defense. Wound in the
> popliteal fossa with profuse bleeding in situ. Distal pulses present.
> Paralysis of ankle and toes dorsiflexion with anaesthesia of the dorsum of
> the foot.
> 
> A CT was done: Head Normal. Minimal perisplenic fluid. Dislocation of the
> proximal tibiofibular joint and fracture of the shaft of the fibula.
> 
> As the spleen laceration was minimal, our general surgeon proposed bed rest
> and observation but at the same time he prevented from lateral decubitus or
> prone positioning for popliteal fossa wound exploration and debridement
> arguing that it could worsen the spleen injury. On the other hand the
> popliteal wound needed debridement.
> 
> I would like to hear opinions about positioning patients whith solid viscus
> injuries?
> 
> Dr. Josep M. Munoz-Vives
> Orthopedic Surgery Dept.
> Hospital Dr. Josep Trueta
> Girona - Catalunya
> Spain
> 
> 
> 
> 
> 

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<P><FONT face="Courier New" size=2>Recently we received a 20 yo old patient that 
suffered a car crash. </FONT></P>
<P><FONT face="Courier New" size=2>GCS 14. Thorax OK. Abdominal pain, no 
abdominal defense. Wound in the popliteal fossa with profuse bleeding in situ. 
Distal pulses present. Paralysis of ankle and toes dorsiflexion with anaesthesia 
of the dorsum of the foot.</FONT></P>
<P><FONT face="Courier New" size=2>A CT was done: Head Normal. Minimal 
perisplenic fluid. Dislocation of the proximal tibiofibular joint and fracture 
of the shaft of the fibula.</FONT></P>
<P><FONT face="Courier New" size=2>As the spleen laceration was minimal, our 
general surgeon proposed bed rest and observation but at the same time he 
prevented from lateral decubitus or prone positioning for popliteal fossa wound 
exploration and debridement arguing that it could worsen the spleen injury. On 
the other hand the popliteal wound needed debridement.</FONT></P>
<P><FONT face="Courier New" size=2>I would like to hear opinions about 
positioning patients whith solid viscus injuries?</FONT></P>
<P><FONT face="Courier New"><FONT size=2>Dr. Josep M. Munoz-Vives<BR>Orthopedic 
Surgery Dept.<BR>Hospital Dr. Josep Trueta<BR>Girona - Catalunya<BR>Spai<SPAN 
class=570292810-13122002>n</SPAN></FONT></FONT></P>
<P><FONT face="Courier New"><FONT size=2><SPAN 
class=570292810-13122002></SPAN></FONT></FONT>&nbsp;</P></DIV></DIV></BODY></HTML>


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