Sarah Ben was driving in College Park, Md., one day last August when she was hit broadside at an intersection by another car. The results were devastating. The 21-year-old college student’s head injuries were so serious they caused seizures, and both her hip and pelvis were shattered. It seemed unlikely she would ever again walk normally or without pain. When Clif Turen, a Hopkins orthopedic surgeon who specializes in treating severe trauma to the pelvis, took a look at Ben’s X-rays he was astounded. She had a serious two-column fracture of her hip socket—the most complex of complex fractures. In most such fractures, some part of the joint is still attached to the pelvis, which surgeons use to begin rebuilding. But in two-column fractures, the socket becomes disconnected, free-floating fragments of bone. Ben’s fracture was one of the worst Turen had seen. Turen knew he had to operate fast as the pelvis tends to heal quickly, making it difficult to move fragments from connective tissue and muscle—and reducing the chances for a successful surgery. He also had to expose as much of the pelvis as possible to see what imaging didn’t reveal. In these fractures, he explains, "he hard part isn’t knowing how to get to the pelvis, but figuring out what’s broken." In Ben’s case, Turen got a good view of the wreckage, and it was extensive. He began what would be five hours of painstaking work in which he pieced and screwed the fragments together as he visualized how the reset pieces would work in a moving hip. The surgeon, Turen explains, must constantly think about the relationship of the hip ball and socket as it sits within the pelvis, which is more complex than the mechanism of joints like the knee or ankle: "And we also have to anticipate how work on one side of the pelvis will affect function on its other side. You’re working very much on indirect maneuvers in strange territory, and you don’t have that same control as you do with other joints." The goal is to reduce any friction between the bones. If the surgeon leaves any boney bends or ridges, the patient’s risk of painful, post-traumatic arthritis—and another operation—increases. Ben came through it all wonderfully. "I’m walking fine, and I don’t have any pain at all,” she reports. "I get a little more tired, but that’s about it." -- Gary Logan,
Hopkins Medical News, Fall 2001 |
