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General Orthopaedics

LOWER LIMB TRAUMATIC AMPUTATIONS: THE IMPORTANCE OF PELVIC BINDING FOR ASSOCIATED PELVIC FRACTURES IN BLAST INJURY

12th Combined Meeting of the Orthopaedic Associations (AAOS, AOA, AOA, BOA, COA, NZOA, SAOA)



Abstract

Introduction

A common injury pattern in current military experience is traumatic lower limb amputation from improvised explosive devices. This injury can co-exist with pelvic girdle fractures.

Methods

We reviewed 67 consecutive patients with traumatic lower limb amputations treated in Camp Bastion Hospital, Afghanistan.

Results

16 (24%) had an associated pelvic fracture (10 APC/vertical shear and 6 acetabular or pubic rami fractures). Traumatic single amputees (n=28) had a 14% incidence of associated pelvic fracture with traumatic double amputees (n=39) increasing this association to 31%. However, if the double amputations were above knee, the incidence of associated open book fractures was 26% (6/23) with 39% (9/23) sustaining some form of bony pelvic injury. The majority of patients (95%) had a pelvic X-ray as part of the primary survey. Of these 51% (n=34) had a Sam sling(r) in situ but only fifteen were deemed appropriately applied.

Conclusions

Given the high risk of pelvic fractures in patients with traumatic bilateral lower limb amputations, particularly those involving opening of the pelvic ring, it is imperative that the earliest and proper application of a pelvic binder be initiated.