Partial traumatic
hemipelvectomy is a devastating condition. Although by definition the affected limb is not totally transected from the trunk because of retained soft tissue, the reported mortality rate is actually higher than in complete traumatic
hemipelvectomy. Between January 2000 and December 2011, a total of 917 patients were admitted to the authors' institution for pelvic fracture. Seven of these patients met the criteria for partial traumatic
hemipelvectomy. All 7 patients had multiple associated
injuries and met the criteria for Baskett class IV
hypovolemic shock on arrival at the emergency department. The amount of
bleeding was the greatest issue, and control of
hemorrhage and rapid
blood transfusion were the initial goals. Abdominal aorta balloon occlusion,
laparotomy and packing, and pelvic external fixation were useful to control
bleeding. Two patients died during the initial
resuscitation phase. Angiography (digital subtraction or computed tomographic) was performed in 4 patients but did not provide any treatment-altering information. Limb preservation was attempted in 2 patients; both of these patients eventually required hindquarter
amputation. One patient died, and the second patient survived after a difficult postoperative course. The best results were obtained in 3 patients who underwent completion of the hindquarter
amputation within 24 hours of
trauma. All patients became wheelchair dependent, and no patient was able to return to work. Early completion of hindquarter
amputation after hemorrhaging has been controlled is recommended in patients with partial traumatic
hemipelvectomy. Angiography did not prove useful in decision making.