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Thu Mar 22 18:08:01 GMT 2007

If you believe that the limb will be non-functionable, and you continue to find myonecrosis, find another orthopedic surgeon - the kid needs a hemipelvectomy.

>>> Joe Nold <jnoldscarmaker at yahoo.com> 3/22/2007 10:06 AM >>>
I have an interesting case and would like to hear the groups take on it.

  24 y/o male hit by a train, 30mph.
  Injuries include:
  1)  Evisceration thru right flank
  2)  Vertical shear pattern pelvic fracture with exposed iliac wing., Sup Gluteal embolized
  3)  Intraparenchymal contusions, ICP's well controlled
  4)  Bilateral pulmonary contusions and right pneumothorax
  5)  Severely comminuted R tibial plateau fx
  6)   Right rad/ulna fx

  Pt's abdomen explored, no hollow viscus injury, liver injury packed and eventually closed with Surgimend mesh in the flank/midline.

  Right hip debrided multiple times, now most of glutes necrotic.

  Pt developed bilateral calf swelling and right thigh swelling soon after admission and had compartment pressures >50.
  Bilateral 4 compartment fasciotomies and right thigh fasciotomy.

  We have recommended hemipelvectomy and the ortho servic is balking.

  What would you do.

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