MDCT Approach to Pelvic Trauma

3rd National Conference SER 2016Bengaluru, India 23-25 September 2016

K.SHANMUGANATHAN

MDCT Approach to Pelvic Trauma

• OBJECTIVE

• Anatomy – bony, ligaments

• Pelvic Fx - mechanism & classification

• Hemorrhage – surgical principles

• CT signs – guided management

Anatomy

3 mm

Classification

LC

APC

Goals of Young-Burgess Classification

1.Predict the mechanism

2.Determine pelvic stability

3.Hemodynamic status

MDCT Approach to Pelvic Trauma

• PELVIC Fx n = 234 /Yr • LC pattern - 80%

• AP pattern - 14%

• VS pattern - 2%

• CMI pattern - 4%SMH, ANP, ALJ. J.Trauma 2002;53:15-20

MDCT Approach to Pelvic Trauma

• PELVIC Fx n = 234 /Yr • Severe pelvic Fx - 16%

LC3, AP3, CMI, VS

• Less severe pelvic Fx - 84% LC1, LC2, AP1,

AP2

• Pelvic arteriography - 9% SMH, ANP, ALJ. J.Trauma 2002;53:15-20

Imaging

Inlet

outlet

Pelvic Hemorrhage

Pelvic Fracture Hemorrhage

Morbidity & Mortality• Hemorrhage - 14% – 52%

• Sepsis - 9%

• Urinary tract injury – 10% -15%

• Associate injuries – brain, diaphragm, solid organ, organ failure

Pelvic Fracture Hemorrhage

Hemorrhage

• Arterial

• Venous plexus

• Bone

Pelvic Fracture Hemorrhage

Pelvic Hemorrhage

• Arterial - arteriography & embolization

• Bone – binder or external fixation

• Venous plexus – ?

• Extra pelvic – surgery or IR

PELVIC FRACTURE HEMORRHAGE

Fracture Pattern & Hemodynamic Instability

• Stable pelvic Fx - 70% peritoneal VS 10%

extra-peritoneal pelvic bleeding

• Unstable pelvic Fx - 40% peritoneal VS 60%

extra-peritoneal pelvic bleeding

v = hπr2/3

Pelvic Fracture Hemorrhage

OPTIMAL OUTCOME • Multi-disciplinary approach

• Trauma surgeon

• Orthopedic surgeon

• Radiology (ER & IR)

MDCT Signs

LTRT

RT Iiac artery LT Iiac artery