Piercing Injury of the Pelvis With a Steel Bar

Abstract

A piercing or penetrating injury of the pelvis by a steel bar is a rare condition compared with piercing or penetrating injuries of the extremities. We report the case of a 34-year-old woman who attempted a suicidal fall that resulted in the piercing of the pelvis with a long steel bar. The steel bar entered the pelvic cavity from the left buttock through the sciatic notch and was bent at the middle of the pelvic cavity between the bladder and rectum. At the right hip joint, the rod penetrated the posteromedial aspect of the femoral head, was bent again, and extended straight along the medial border of the femur without damaging the femoral neurovascular bundle. At the middle one-third level, the bar spanned in a posterolateral direction and then down toward the lateral aspect at the level of the mid-calf. The bar exited the lateral side of the left calf. An explorative laparotomy was performed to ensure that no intraperitoneal injury had occurred. The smaller portion of the uterus bicornis was the only organ that had been pierced. The penetrated uterus was incised to expose the bent portion of the bar. The bar was cut in half using a diamond burr, and the cutting edge was trimmed so as not to injure the surrounding organs during removal. The second bent portion of the rod, located in the right hip joint, was straightened by positional reduction, and the hip joint was abducted under fluoroscopic monitoring from outside of the operative field by grasping the end of the bar remaining in the pelvic cavity. The steel bar was safely removed and treated after careful planning and multiteam approaches with a general surgeon and orthopedic trauma specialists.