RECOVERED JIA IN HIKING  WITH NO NOTICEABLE LEG LENGTH DISCREPANCY

At the moment when falling from the sixth floor, 13-year-old Jia's mind went all blank.

When she woke up, she was already in hospital with multiple severe traumas all over her body and completely unable to move her limbs. "Will I still be able to paint or dance?" Jia was filled with fear for the future. 

Fortunately, Jia has basically regained her mobility now. A few days ago, in a video clip her father Mr. WU sent to the doctor, Jia was cheerfully pedaling a stationary bike, as if she had never been injured.

However, behind the seconds-long video clip, it was a journey with hope and hardships to recovery.

Bone Deformity Due to Accidental Fall From Height

It was on April 12th 2020 when Mr. WU received the call telling him his daughter fell from their sixth-floor apartment's balcony. Mr. WU rushed to the hospital immediately in desperation.

Jia is an outgoing girl who loves painting and dancing. That day, she was painting at home alone. She was so satisfied with her work that she decided to hang it on the wall of the balcony, then the accident happened.

Jia was injured severely from the forceful impact of falling from 15-meter height. She was diagnosed with aortic coarctation, hemopneumothorax, contusions, intestinal perforation, intracranial hemorrhage, and multiple fractures, any of these injuries could take her life in minutes.

Luckily, Jia had timely rescue and survived. But because of her severe condition, the management of her pelvic fracture is only secondary with the treatment of her internal organ damage to be the priority at that moment.

After three months, Jia's internal organ damage was basically healed, so was her pelvic fracture which, however, resulted in a pelvic deformity that caused the leg length discrepancy – Jia's left lower limb was 5 cm shorter than her right lower limb.

Nerves and Venous Plexus at the Fracture Site Increase Her Risk of Paralysis

Jia was admitted into the SAHZU Orthopedics with Dr. XIN Zengfeng, head of pediatric orthopedics, as her charge doctor. Dr. XIN operated on JIA together with Dr. LI Weixu, the head of orthopedic trauma and a nationally well-known expert in pelvic and acetabular fracture.

Surgical treatment of old pelvic fractures is known to be a complex and difficult procedure, which could be very challenging for orthopedic surgeons. The pelvis contains a variety of internal organs and complex blood vessels and nerves. Once the healing mechanism is activated after a pelvic injury, it can lead to extensive adhesions to organs, blood vessels and nerves adjacent to the fracture site, which can easily cause damage, further increasing the risk of surgery.

Moreover, in Jia's case, one of her fracture sites is located in the sacrum, which is the main cause of her deformity and must be corrected, yet there are important nerves and venous plexus along the fracture line. If injured, hemorrhage or paralysis of the lower limbs are possible consequences. Either is unacceptable for Jia and her family.

Perioperative Practice on the 3D Printed 1:1 Scale Models

In the end, Dr. LI Weixu decided not to operate on the site of the sacral fracture. Instead, he chose to perform an osteotomy on the adjacent iliac bone to adjust the relationship of the surrounding normal structures, so as to restore the symmetry and stability of Jia's pelvis. In this way, not only could potential damage to the nearby nerves and venous plexus of fracture site be avoided, but also the length and function of Jia's lower limbs could be fixed.

However, individual differences in pelvic deformities are huge, and it is not easy to correct the asymmetry caused by the deformity while minimizing the interference with the surrounding normal structures. Dr. LI Weixu therefore made a 1:1 scale model of Jia's pelvis based on her CT data through 3D printing technology, and simulated the surgery on the model.

The advantage of preoperative planning based on 3D printing technology is that the attending surgeon is able to perform the surgery in simulation in advance. This not only allows for more precision in the surgery design, but also in the prediction of the surgery outcome.

More importantly, with the rehearsal, difficulties and risks that may be encountered during the surgery can be prepared beforehand, which can significantly shorten the operation time, reduce intraoperative bleeding, improve the success rate, and enhance the patient recovery.

With careful planning and preparation, after 5-hour hard work of Dr. LI Weixu and Dr. XIN Zengfeng and their team, the osteotomy orthopedic surgery for Jia's pelvic fracture deformity was finally completed successfully. The day after the surgery, when Jia made the gesture of "Yeah" to Dr. XIN in the hospital bed, everyone felt relieved.

In less than one week, Jia was discharged with rapid recovery. Videos of Jia having follow-ups and rehabilitation are often sent to Dr. XIN by Mr. WU.