Hereditary multiple exostoses (HME) and pelvic trauma

Case contributed by Dr Matt Skalski

Presentation

Motor vehicle accident.

Patient Data

Age: 21
Gender: Male

Numerous osseous excrescences with medullary continuity are observed extending off of the bilateral ilii, proximal femora, and pubic rami, as well as the sacrum. 

There are mildly displaced fractures of the bilateral superior pubic rami, left inferior pubic ramus, and right ischium. The fractures of the left and right superior pubic rami are comminuted. 

The superior aspect of the sacroilliac joints appear fused. 

Additional osseous excressences are observed at multiple sites on the ribs and at the right transverse process of L3. 

Again noted are fractures through the left superior and inferior pubic rami, with the fracture of the left inferior pubic ramus extending into the left parasymphyseal region, and the comminuted left superior pubic ramus fracture extending into the anterior column of the left acetabulum. The right superior ramus fracture is non-comminuted and minimally displaced. There is no right inferior pubic ramus fracture, however the right ischium demonstrates a hair-line fracture. 

An additional comminuted fracture through the right sacral ala is noted, which extends into the right sacroiliac joint. Transverse process fractures are observed on the left at L1, L2, L3, and L4, with a distracted L5 right transverse process fracture.

The exuberant osseous excrescences bordering the sacroiliac joints cause multiple sites of fusion along the posterior aspect of the joint spaces bilaterally. 

The inferior vena cava is diminutive, likely from significant volume loss. There is extensive retroperitoneal hemorrhage, which appears to begin immediately superior to the bifurcation of the inferior vena cava where it fails to opacify. This hemorrhage extends into the pelvis, predominately on the right. The right common iliac vein is not well visualized near its origin. No definitive sites of arterial extravasation are identified.

Case Discussion

Occasionally trauma evaluation can be made difficult by superimposed pathology such as HME, which in this case is extensive. No sites concerning for malignant degeneration of an osteochondroma were identified. 

See related articles for relevant discussions of the individual pathologies. 

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Case information

rID: 37204
Case created: 28th May 2015
Last edited: 9th May 2017
Inclusion in quiz mode: Included

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