Post on 13-Jul-2015
PELVIC INJURIES
DEFINITION
Injuries or fractures that involve the pelvis bone and structure
Why important?
Highest mortality in pelvic fractures
Rates can reach 20%
Amount of force causing unstable pelvic fractures also causes severe organ damage
When to suspect…
High velocity MVA (eg…)
Obvious wounds…Severe hypovolemicshock (class II and above)
Bruises around flank or pelvis
When to suspect… (subtle signs)
Haematuria
If suspect pelvic injury…
Disrupts pelvic ring
Not disrupting pelvic ring
Pelvic ring
Injuries disrupting the pelvic ring
Open book fracture
Vertical shear fracture
Injuries not disrupting pelvic ring
Pubic rami fractures
Iliac wing fractures
What is most important?
HYPOVOLEMIC SHOCK!
Why it bleeds so much?
Pre-sacral venous plexus overlies the SI joint
Fracture disrupts SI joint
Tears the veins
BLEEDS!
Pelvis forms a limited container
Disrupted pelvic ring opens this container
Haemorrhage leaks into retroperitoneum
MASSIVE BLEED (5-6 LITRES)
What to do?
A&E level
Follow ATLS protocol (ABCDE)
Most important to fluid resuscitate
As massive bleeding suspected – blood must be transfused (volume expanders while waiting blood)
Application of temporary pelvic stabilizer (binder / c-clamp)
Pelvic binder
C-clamp
What to do?
Orthopaedic role
To decrease pelvis volume by stabilizing with external fixators
Why? – to contain the haemorrhage
Bleeding will stop due to TEMPONADE effect
How to do?
Pin placement:
2cm posterior to ASIS along iliac crest
Reduction:
If open book – internal rotate the hip
If vertical shear – traction through a supracondylarpin 1st
Hold:
At least 2 bars must be clamped together
Pelvic # classification (Tile’s)
Type A – STABLE
A1 – # not involving ring
A2 – stable, minimally displaced ring #
Type B – Rotation unstable, Vertical stable
B1 – open book
B2 – lateral compression: ipsilateral
B3 – lateral compression: contralateral
B1 B2
Type C – Rotation & Vertically unstable
C1 – Vertical shear
C2 – bilateral vertical shear
C3 – a/w acetabular #
C1
THANK YOU