What is pelvic reconstructive surgery that Dr Anahita Pandole underwent?

Dr Anahita Pandole, who was driving the car that tragically crashed on September 4, resulting in the deaths of two passengers including former Tata Group chairman Cyrus Mistry, has been operated upon for pelvic reconstruction by an expert team of doctors at Sir HN Reliance Foundation Hospital. Dr Pandole and her husband Darius Pandole were seriously injured in the high-speed crash.

Given the complex pelvic fracture, multiple opinions of various experts around the world were taken, including doctors from USA, UK, Europe and more. Dr Peter V Giannoudis was flown from the UK for providing the team with expert advice. He is the Chairman with Academic Department of Trauma and Orthopaedics Surgery at University of Leeds, UK.

“With team of 20-plus multi-disciplinary experts, we have been monitoring the condition of Dr Anahita closely for the last 11 days before planning any surgical intervention. Pelvic surgery was concluded today morning with precise techniques, clinical skills and modern technologies. This will enable her to achieve the recovery of the injuries caused post the traumatic accident. I am grateful to our surgical teams and for the advisory provided by Dr Peter V Giannoudis,” said Dr Tarang Gianchandani, CEO, Sir HN Reliance Foundation Hospital.

“The team that conducted the surgery includes Dr Vaibhav Bagaria, Director, Department of Orthopaedics, Dr Dilip Tanna, Mentor Orthopedics, Dr Darius Soonawala, Consultant Orthopedics and senior anesthetist Dr Daisy along with trained nurses and technicians,” added Dr Gianchandani.

WHAT IS A CAR-CRASH CAUSED PELVIC TRAUMA?

Dr Pandole suffered traumatic hemipelvectomy, which involves a catastrophic fracture of the pelvis as a result of high-energy trauma such as in a car accident. According to a 2013 study by the US-based National Library of Medicine, “The incidence of traumatic hemipelvectomy is rare, but it is a devastating injury. Recently, an increasing number of patients with traumatic hemipelvectomy are admitted to trauma centres alive due to improvements of the pre-hospital care. Successful management requires prompt recognition of the nature of this injury and meticulous surgical technique.”

Listing the types of injury, it further said, “Due to the immense external forces involved, the injured limb is usually extremely rotated and dorsiflexed, resulting in complete separation of the pubic symphysis and the sacroiliac joint…more than 40 per cent of traumatic hemipelvectomy cases belong to this type of injury. A second mechanism of injury involves the limbs and pelvis, which are entangled by heavy machinery such as the chassis of a vehicle, harvester combines or conveyor belts. In addition, patients are directly injured by heavy objects, in which the upper body is thrown out of a vehicle while the legs are entangled in the car as well as the direct blow of a yacht propeller, which can also result in traumatic hemipelvectomy.”

HOW CAN SURVIVORS OUTLAST THE TRAUMA?

According to the study, “The leading causes of death in patients with traumatic hemipelvectomy are blood loss, infections and multiple organ failure. The successful rescue of these patients depends on the following key steps: First, hemorrhage control and vigorous resuscitation. Direct clamping of the large bleeding vessels should be the first step in resuscitation. It has been acknowledged that circumferential compression with a sheet is a cost-effective method of hemostasis. Wrapping the circumference of the pelvis with sheets and knotting in front of the pelvis can form a wound compression bandage that is effective in controlling bleeding in cases with a complete separation of the injured limb from body. However, this method is sometimes less than ideal for circumstances in which the injured limb is still partially attached to the trunk. In such cases, hemipelvectomy is a life-saving intervention. It has been reported that the early angiography and subsequent embolisation should be considered in cases of continued unexplained blood loss.”

WHAT IS PELVIC RECONSTRUCTIVE SURGERY?

There is no one formula that can be applied but broadly speaking this could involve amputation, debridement, haemorrhage control, bone re-alignment or reconstruction with implants and wound closure. As per an online journal of the US orthopaedic hospital HSS, Dr David L. Helfet says that the pelvis protects most of our lower organs. Pelvic fractures may occur at any location on the bones depending on the nature of the accident and the areas of impact.

“The acetabulum refers to the part of the pelvis that meets the upper end of the thigh bone (the femoral head to form the hip joint. In a healthy hip, these two bones fit together like a ball and cup, in which the ball rotates freely in the cup. Cartilage lines the bones where they meet at the joint and there is little friction between the surfaces during movement. Fractures of the acetabulum are harder to treat because access to this bone is more difficult, and because of the acetabulum’s proximity to the major blood vessels to the legs, the sciatic nerve (the major nerve that arises from the lower spine and provides sensation and movement to the leg and foot), the intestines, the ureter and the bladder. Unlike a hip fracture, which can be treated relatively easily, to repair an acetabular fracture, the orthopedic surgeon must, in essence, fix the broken bones from the inside out. In fractures of this type, the femoral head is often driven through the acetabulum because of the impact of the fall or accident. If the femoral head ends up outside the acetabulum, this is known as a dislocation of the hip joint. Some patients have both a fracture and a dislocation,” he says.

There is risk of bleeding and nerve damage. Apart from the key organs, even the broken bones have to be stabilised, which is why the surgery on Dr Pandole was conducted after a gap. Sometimes the surgeons clamp the broken bones to hold them in position. Then surgeons may use plates and screws internally to hold the bones in place. Depending on the location and complexity of the fracture, the surgeon may have to fix the front of the pelvis, the back of the pelvis, or both. Separate operations may be needed for each area that needs treatment.

“The surgeon realigns or reduces the bones as precisely as possible to prevent the development of post-injury related problems, especially arthritis. The bones are rigidly fixed with plates and screws to prevent future displacement and allow for rehabilitation to begin as quickly as possible,” writes Dr Helfet.


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