Medical Photo of the Week (NEJM)
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"A 45-year-old man was brought to the emergency department after a motorcycle accident. He had a history of low back pain and disk herniation and had undergone transforaminal lumbar interbody fusion of the L5 to S1 vertebrae 5 years earlier. The physical examination was notable for a bruise in the pubic area, and manual compression elicited severe pain in the anterior and posterior pelvic areas, findings consistent with an unstable pelvis. Circumferential pelvic sheeting was applied to stabilize the pelvic ring. A radiograph of the pelvis showed a widening of the pubic symphysis of more than 5 cm. Also known as an open-book fracture, this injury typically occurs after high-energy blunt trauma, such as that caused in a motorcycle accident or by a fall from height. Such injuries may cause extensive bleeding and neurologic damage and may be associated with urogenital injuries. To restore the stability of the posterior pelvic rim, a Pfannenstiel approach was used for internal plate fixation, augmented with a supra-acetabular external skeletal fixator for the anterior rim and a percutaneous sacroiliac screw for fixation of the left posterior rim. The patient was able to sustain partial weight bearing with crutches after the surgery and participated in rehabilitation. Within 2 months after surgery, the external fixator was removed, and he was able to bear his full weight."
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Mmmm that could hurt
