case_images: PMC8112908_01
case_images: Initial anteroposterior pelvis X-ray showing bilateral pubic rami fractures and a large uterine fibroid, in a 65-year-old patient pedestrian struck by a motor vehicle.
case_images: CRIOR2021-5594270.001.jpg
case_images: PMC8112908_01_CRIOR2021-5594270.001.jpg
case_images: fig1
case_images: The patient was known to have a history of uterine fibroid which was visualized on the pelvic radiograph (Figure 1).
case_images: Picture showing the vaginal laceration through which the fractured bony fragment was assessed for irrigation and debridement.
case_images: CRIOR2021-5594270.002.jpg
case_images: PMC8112908_01_CRIOR2021-5594270.002.jpg
case_images: fig2
case_images: OB/GYN performed vaginal examination and identified several lacerations: (a) 7 o'clock partial thickness tear; (b) 5 o'clock two-inch-deep, full-thickness laceration communicating with the left inferior pubic rami fracture (Figures 2 and 3); (c) 3 cm area of dead space surrounding the fractured edge.
case_images: Primary closure of open vaginal wall injury.
case_images: CRIOR2021-5594270.003.jpg
case_images: PMC8112908_01_CRIOR2021-5594270.003.jpg
case_images: fig3
case_images: OB/GYN performed vaginal examination and identified several lacerations: (a) 7 o'clock partial thickness tear; (b) 5 o'clock two-inch-deep, full-thickness laceration communicating with the left inferior pubic rami fracture (Figures 2 and 3); (c) 3 cm area of dead space surrounding the fractured edge.
case_images: Surgeon made antibiotic-coated Polymethyl methacrylate (PMMA) beads surrounded by metronidazole gel.
case_images: CRIOR2021-5594270.004.jpg
case_images: PMC8112908_01_CRIOR2021-5594270.004.jpg
case_images: fig4
case_images: The OB/GYN team performed closure of the vaginal wound and packed the vagina with a gauze roll coated with metronidazole gel, as per standard of care (Figure 4).
case_images: Anteroposterior pelvis radiograph showing the external fixator in place and the antibiotic beads surrounding the left inferior pubic rami fracture.
case_images: CRIOR2021-5594270.005.jpg
case_images: PMC8112908_01_CRIOR2021-5594270.005.jpg
case_images: fig5
case_images: Final images demonstrated acceptable positioning of the pelvic ring and placement of antibiotic beads (Figure 5). The patient maintained external fixation placement for 8 weeks (Figure 5), weight-bearing as tolerated (WBAT) on the right, and toe touch weight-bearing (TTWB) on the left.
case_images: Anteroposterior pelvis radiograph after removal of the external fixator with healing of pubic rami fractures and presence of the antibiotic beads.
case_images: CRIOR2021-5594270.006.jpg
case_images: PMC8112908_01_CRIOR2021-5594270.006.jpg
case_images: fig6
case_images: The patient was ambulating well with minimal discomfort (Figure 6).