ONE-STAGE OPERATION FOR PELVIS AND ACETABULAR FRACTURES COMBINED WITH Morel-Lavallée INJURY BY INTERNAL FIXATION ASSOCIATED WITH VACUUM SEALING DRAINAGE_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WEIDan ,  WANGYue , YUANJiabin , TANGXiaoming , ZHANGBin , LUBing , TANBo

Department of Orthopedics, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu Sichuan, 610072, P. R. China;

Corresponding?author：

WANGYue, Email: wangyue@medmail.com.cn

Keywords：

Morel-Lavallée injury; Pelvis fracture; Acetabular fracture; Fracture internal fixation; Vacuum sealing drainage

DOI：

10.7507/1002-1892.20140009

Video：

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Objective To investigate the methods and effectiveness of one-stage operation for pelvis and acetabular fractures combined with Morel-Lavallée injury by internal fixation associated with vacuum sealing drainage (VSD). Methods Between June 2008 and October 2012, 15 cases of pelvis and acetabular fractures combined with Morel-Lavallée injury were treated. There were 5 males and 10 females, aged from 18 to 67 years (mean, 36.8 years). Fractures were caused by traffic accident in 11 cases and crashing injury of heavy object in 4 cases. The time from injury to hospitalization was 3 hours to 9 days (mean, 5.4 days). Morel-Lavallée injury located in the above posterior superior iliac spine in 4 cases, greater trochanter in 7 cases, and anterior proximal thigh in 4 cases. In 10 cases complicated by pelvic fracture, there were 1 case of anteroposterior compression type, 3 cases of lateral compression type, 5 cases of vertical shear type, and 1 case of compound injury type; in 5 cases complicated by acetabular fracture, there were 1 case of transverse fracture, 1 case of posterior wall and posterior column fracture, 1 case of transverse acetabulum plus posterior wall fracture, and 2 cases of both columns fracture. Open reduction and internal fixation were used to treat pelvic and acetabular fractures, and VSD to treat Morel-Lavallée injury. When the drainage volume was less than 20 mL/d, interrupted wound suture or free skin grafting was performed. Results The hospitalization time was 16-31 days (mean, 20.8 days). Thirteen cases were followed up 4-16 months (mean, 7.8 months). The healing time of Morel-Lavallée injury was 16-36 days after operation (mean, 21.3 days). All the wounds had primary healing, and no infection occurred. The X-ray films showed that all fractures healed, with a mean healing time of 13.6 weeks (range, 11-18 weeks). At 6.5 months after operation, according to Majeed function scoring system in 8 cases of pelvic fracture, the results were excellent in 5 cases, good in 2 cases, and fair in 1 case; according to Harris hip scoring in 4 cases of acetabular fracture, the results were excellent in 2 cases, good in 1 case, and fair in 1 case. Conclusion To pelvis-acetabular fractures combined with Morel-Lavallée injury, internal fixation treatment for fracture and VSD for Morel-Lavallée injury not only can cure merge Morel-Lavallée injury effectively, but also can guarantee the operation timing and incision safty of the pelvis-acetabular fractures.

Citation： WEIDan, WANGYue, YUANJiabin, TANGXiaoming, ZHANGBin, LUBing, TANBo. ONE-STAGE OPERATION FOR PELVIS AND ACETABULAR FRACTURES COMBINED WITH Morel-Lavallée INJURY BY INTERNAL FIXATION ASSOCIATED WITH VACUUM SEALING DRAINAGE. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(1): 38-42. doi: 10.7507/1002-1892.20140009 Copy

1.	Suzuki T,Hak DJ,Ziran BH,et al.Outcome and complications of posterior transiliac plating for vertically unstable sacral fractures.Injury,2009,40(4):405-409.
2.	Kalaci A,Karazineir S,Yanat AN.Long-standing Morel-Lavallée lesion of the thigh simulating a neoplasm.Clin Imaging,2007,31(4):287-291.
3.	Luta V,Enache A,Costea C.Posttraumatic Morel-Lavallée seroma-clinic and forensic implication.Rom J Leg Med,2010,18(1):31-36.
4.	Luria S,Applbaum Y,Weil Y,et al.Talc sclerodhesis of persistent Morel-Lavallée lesions (posttraumatic pseudocysts).J Orthop Trauma,2006,20(6):435-438.
5.	Jones RM,Hart AM.Surgical treatment of a Morel-Lavallée lesion of the distal thigh with the use of lymphatic mapping and fibrin sealant.J Plast Reconstr Aesthet Surg,2012,65(11):1589-1591.
6.	Hak DJ,Olson SA,Matta JM.Diagnosis and management of closed internal degloving injuries associated with pelvic and acetabular fractures:the Morel-Lavallée lesion.J Trauma,1997,42(6):1046-1051.
7.	胥少汀,葛寶豐,徐印坎.實用骨科學.3版.北京:人民軍醫出版社,2005:649-665.
8.	Letournel E.Acetabulum fractures:classification and management.Clin Orthop Relat Res,1980,(151):81-106.
9.	Sagi HC,Ordway NR,DiPasquale T.Biomechanical analysis of fixation for vertically unstable sacroiliac dislocations with iliosacral screws and symphyseal plating.J Orthop Trauma,2004,18(3):138-143.
10.	蔣協運,王大偉.骨科臨床療效評價標準.北京:人民衛生出版社,2005:129-130.
11.	李力更,吳嘯波,孫柏山,等.聚乙烯乙醇水化海藻鹽泡沫材料覆蓋負壓封閉引流在髖臼骨折合并Morel-Lavallée損傷內固定前的應用.中國組織工程研究,2012,16(25):4667-4670.
12.	Tseng S,Tornetta P 3rd.Percutaneous management of Morel-Lavallée lesions.J Bone Joint Surg (Am),2006,88(1):92-96.
13.	梁彥,李衛哲,云才,等.不穩定型骨盆骨折合并Morel-Lavallée損傷的手術治療.中國矯形外科雜志,2012,20(22):2098-2101.
14.	Vaidya B,Colen R,Vigdomhik J,et al.Treatment of unstable pelvic ring injuries with an internal anterior fixator and posterior fixation:initial clinical series.J Orthop Trauma,2012,26(1):1-8.
15.	孫玉強,唐明杰,宋文奇,等.有限切開復位內固定治療Tile C型骨盆骨折.中華創傷骨科雜志,2012,14(5):395-398.
16.	Mears DC,Velyvis JH,Chang CP.Displaced acetabular fractures managed operatively:indicators of outcome.Clin Orthop Relat Res,2003,(407):173-186.
17.	王秋根,王謙.骨盆骨折損傷控制的回顧及展望.中華創傷雜志,2011,27(4):289-292.
18.	張建,吳克儉,張偉佳,等.全螺紋加壓無頭空心螺釘經皮固定骨盆骨折.中國修復重建外科雜志,2012,26(1):91-96.
19.	鄭仕偉,張巖,楊鐵毅,等.微創鋼板內固定重建骨盆環穩定性.中國修復重建外科雜志,2011,25(9):1087-1089.
20.	張巍,羅從風,胡承方,等.三維透視斷層成像導航下微創治療髖臼骨折初步報道.中國修復重建外科雜志,2011,25(5):517-520.
21.	胡煒,高金華,郭曉山,等.單一髂腹股溝入路治療復雜髖臼骨折.中醫正骨,2013,25(2):110-112.
22.	魏丹,王躍,袁加斌,等.復合髖臼骨折手術中后方入路的特點和選擇.創傷外科雜志,2010,12(5):392-394.

1. Suzuki T,Hak DJ,Ziran BH,et al.Outcome and complications of posterior transiliac plating for vertically unstable sacral fractures.Injury,2009,40(4):405-409.
2. Kalaci A,Karazineir S,Yanat AN.Long-standing Morel-Lavallée lesion of the thigh simulating a neoplasm.Clin Imaging,2007,31(4):287-291.
3. Luta V,Enache A,Costea C.Posttraumatic Morel-Lavallée seroma-clinic and forensic implication.Rom J Leg Med,2010,18(1):31-36.
4. Luria S,Applbaum Y,Weil Y,et al.Talc sclerodhesis of persistent Morel-Lavallée lesions (posttraumatic pseudocysts).J Orthop Trauma,2006,20(6):435-438.
5. Jones RM,Hart AM.Surgical treatment of a Morel-Lavallée lesion of the distal thigh with the use of lymphatic mapping and fibrin sealant.J Plast Reconstr Aesthet Surg,2012,65(11):1589-1591.
6. Hak DJ,Olson SA,Matta JM.Diagnosis and management of closed internal degloving injuries associated with pelvic and acetabular fractures:the Morel-Lavallée lesion.J Trauma,1997,42(6):1046-1051.
7. 胥少汀,葛寶豐,徐印坎.實用骨科學.3版.北京:人民軍醫出版社,2005:649-665.
8. Letournel E.Acetabulum fractures:classification and management.Clin Orthop Relat Res,1980,(151):81-106.
9. Sagi HC,Ordway NR,DiPasquale T.Biomechanical analysis of fixation for vertically unstable sacroiliac dislocations with iliosacral screws and symphyseal plating.J Orthop Trauma,2004,18(3):138-143.
10. 蔣協運,王大偉.骨科臨床療效評價標準.北京:人民衛生出版社,2005:129-130.
11. 李力更,吳嘯波,孫柏山,等.聚乙烯乙醇水化海藻鹽泡沫材料覆蓋負壓封閉引流在髖臼骨折合并Morel-Lavallée損傷內固定前的應用.中國組織工程研究,2012,16(25):4667-4670.
12. Tseng S,Tornetta P 3rd.Percutaneous management of Morel-Lavallée lesions.J Bone Joint Surg (Am),2006,88(1):92-96.
13. 梁彥,李衛哲,云才,等.不穩定型骨盆骨折合并Morel-Lavallée損傷的手術治療.中國矯形外科雜志,2012,20(22):2098-2101.
14. Vaidya B,Colen R,Vigdomhik J,et al.Treatment of unstable pelvic ring injuries with an internal anterior fixator and posterior fixation:initial clinical series.J Orthop Trauma,2012,26(1):1-8.
15. 孫玉強,唐明杰,宋文奇,等.有限切開復位內固定治療Tile C型骨盆骨折.中華創傷骨科雜志,2012,14(5):395-398.
16. Mears DC,Velyvis JH,Chang CP.Displaced acetabular fractures managed operatively:indicators of outcome.Clin Orthop Relat Res,2003,(407):173-186.
17. 王秋根,王謙.骨盆骨折損傷控制的回顧及展望.中華創傷雜志,2011,27(4):289-292.
18. 張建,吳克儉,張偉佳,等.全螺紋加壓無頭空心螺釘經皮固定骨盆骨折.中國修復重建外科雜志,2012,26(1):91-96.
19. 鄭仕偉,張巖,楊鐵毅,等.微創鋼板內固定重建骨盆環穩定性.中國修復重建外科雜志,2011,25(9):1087-1089.
20. 張巍,羅從風,胡承方,等.三維透視斷層成像導航下微創治療髖臼骨折初步報道.中國修復重建外科雜志,2011,25(5):517-520.
21. 胡煒,高金華,郭曉山,等.單一髂腹股溝入路治療復雜髖臼骨折.中醫正骨,2013,25(2):110-112.
22. 魏丹,王躍,袁加斌,等.復合髖臼骨折手術中后方入路的特點和選擇.創傷外科雜志,2010,12(5):392-394.

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Chinese Journal of Reparative and Reconstructive Surgery

ONE-STAGE OPERATION FOR PELVIS AND ACETABULAR FRACTURES COMBINED WITH Morel-Lavallée INJURY BY INTERNAL FIXATION ASSOCIATED WITH VACUUM SEALING DRAINAGE

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