“…Evidence of anorectal injury should be actively sought, then corroborated either with direct inspection, proctoscopy, or rectal contrast study. 13 Morel-Lavallée lesions are closed degloving injuries caused by separation of the deep and superficial fascial layers by shearing forces, creating a potential space. Vascular and lymphatic injury at this point causes leakage of blood and lymph into this potential space.…”
Section: Discussionmentioning
confidence: 99%
“…Evidence of anorectal injury should be actively sought, then corroborated either with direct inspection, proctoscopy, or rectal contrast study. 13 Figure 6.(a) Axial schematic (2): Puborectalis tear (red line with *). Peri-rectal free gas (Black dots).…”
Background We present a rare case of complete rectal avulsion from the external anal sphincter complex associated with unstable pelvic ring disruption, including spinopelvic dissociation, following rollover by tractor. Purpose In the context of major pelvic trauma, evaluating for unstable bony, acute vascular, urethral and bladder injuries is essential. However, a detailed search for anorectal injury is also required by the reporting radiologist. Research Design: Case Study. Study Sample: 1. Data Collection and/or Analysis Retrospective analysis of computed tomography (CT). Results In this case report we highlight specific pelvic floor anatomy on CT, with a focus on gross morphology and the presence of peri-rectal free gas as primary evidence for injury. Secondary radiological evidence which should trigger the search for anorectal injury includes bony posterior pelvic ring disruption (sacrum or coccyx fractures) or associated Morel-Lavallée lesions. Conclusion The presence of radiological abnormality should prompt direct clinical inspection for corroboration. Early recognition is crucial for joint colorectal and orthopaedic management and the avoidance of delayed pelvic sepsis, which may become intractable.
“…Evidence of anorectal injury should be actively sought, then corroborated either with direct inspection, proctoscopy, or rectal contrast study. 13 Morel-Lavallée lesions are closed degloving injuries caused by separation of the deep and superficial fascial layers by shearing forces, creating a potential space. Vascular and lymphatic injury at this point causes leakage of blood and lymph into this potential space.…”
Section: Discussionmentioning
confidence: 99%
“…Evidence of anorectal injury should be actively sought, then corroborated either with direct inspection, proctoscopy, or rectal contrast study. 13 Figure 6.(a) Axial schematic (2): Puborectalis tear (red line with *). Peri-rectal free gas (Black dots).…”
Background We present a rare case of complete rectal avulsion from the external anal sphincter complex associated with unstable pelvic ring disruption, including spinopelvic dissociation, following rollover by tractor. Purpose In the context of major pelvic trauma, evaluating for unstable bony, acute vascular, urethral and bladder injuries is essential. However, a detailed search for anorectal injury is also required by the reporting radiologist. Research Design: Case Study. Study Sample: 1. Data Collection and/or Analysis Retrospective analysis of computed tomography (CT). Results In this case report we highlight specific pelvic floor anatomy on CT, with a focus on gross morphology and the presence of peri-rectal free gas as primary evidence for injury. Secondary radiological evidence which should trigger the search for anorectal injury includes bony posterior pelvic ring disruption (sacrum or coccyx fractures) or associated Morel-Lavallée lesions. Conclusion The presence of radiological abnormality should prompt direct clinical inspection for corroboration. Early recognition is crucial for joint colorectal and orthopaedic management and the avoidance of delayed pelvic sepsis, which may become intractable.
“…They revealed that only 36 of the 81 patients showed abnormal air on plain radiographs. 18 Due to its limited resolution in space and contrast, thick soft tissues or overlapping bone cause difficulties in detecting air on plain radiographs.…”
The prevalence and distribution of air present in the leg in closed and low-grade open tibial shaft fractures are unknown on multidetector high-resolution computed tomography (CT). The purpose of this study was to determine the rate of surgical site infection (SSI) in cases where debridement was not performed in the area of air infiltration. Methods: Eighty-one closed and low-grade open tibial shaft fractures that underwent multidetector high-resolution CT on admission and were treated with an intramedullary nail were examined retrospectively. Results: Of the 36 Gustilo type I or II open fractures, all had local air around the fracture site (within 5 cm proximal and distal from the fracture center). Of these, 25 showed remote air (more than 5 cm away from the fracture center). The most frequent site of remote air was in the subcutaneous tissue, followed by the anterior compartment and deep posterior compartment. All open fractures were treated with local irrigation and debridement, regardless of the presence of remote air, followed by a reamed intramedullary nail. No SSI developed until bone union. Of the 45 closed fractures, 3 patients showed air in the leg on the CT. No debridement was performed for closed fractures. One patient who did not have air in the leg developed SSI. All fractures united eventually. Conclusions: In low-grade open tibial shaft fractures, air can spread far from the fracture site. Even in closed tibial shaft fractures, air can be identified in the leg. The debridement of the area of air infiltration, however, is not necessary for prevention of SSI.
“…Based on the classification alone, the expected blood loss in initially hemodynamically stable patients can be predicted. This classification can be rapidly applied from native CT data during the early care of poly-trauma patients if appropriate care protocols exist (9,10). Trauma severity, decreased haemoglobin concentration and low blood pressure all indicated slight tendencies towards worse fracture types, but differences between the three fractures groups did not prove statistically significant.…”
Background:The main cause of mortality after pelvic ring fractures is the acute haemorrhagic shock. The aim of the study was to estimate blood loss using CT and to correlate estimated blood loss to the mortality.Methods: A retrospective analysis of 42 patients with AO/OTA C-type pelvic ring fractures was performed.In total 29 AO/OTA C1-type, 4 C2-type and 9 C3-type fractures were analysed. A CT-volumetric analysis was developed to estimate the early blood loss in the different compartments. The results were correlated to the mortality of the patients.Results: Significant increases in interstitial free blood volume (392±502.8 vs. 888±663; P<0.05) and total blood loss (476±535 vs. 1,005±649; P<0.05) were seen when comparing C1 to C3-type fractures. Early blood loss significantly correlated to mortality. No significant difference was seen between all groups with respect to systolic blood pressure, haemoglobin concentration and the Injury Severity Score (ISS).
Conclusions:In pelvic ring fractures the CT-estimated blood loss correlates to mortality.
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