Pelvic injuries trauma 2012
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Transcript of Pelvic injuries trauma 2012
![Page 1: Pelvic injuries trauma 2012](https://reader034.fdocuments.in/reader034/viewer/2022042512/55a3dd9a1a28abd81f8b472f/html5/thumbnails/1.jpg)
PELVIC INJURIES
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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
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When to suspect…
High velocity MVA (eg…)
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Obvious wounds…Severe hypovolemicshock (class II and above)
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Bruises around flank or pelvis
When to suspect… (subtle signs)
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Haematuria
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If suspect pelvic injury…
Disrupts pelvic ring
Not disrupting pelvic ring
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Pelvic ring
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Injuries disrupting the pelvic ring
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Open book fracture
Vertical shear fracture
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Injuries not disrupting pelvic ring
Pubic rami fractures
Iliac wing fractures
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What is most important?
HYPOVOLEMIC SHOCK!
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Why it bleeds so much?
Pre-sacral venous plexus overlies the SI joint
Fracture disrupts SI joint
Tears the veins
BLEEDS!
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Pelvis forms a limited container
Disrupted pelvic ring opens this container
Haemorrhage leaks into retroperitoneum
MASSIVE BLEED (5-6 LITRES)
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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)
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Pelvic binder
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C-clamp
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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
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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
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Pelvic # classification (Tile’s)
Type A – STABLE
A1 – # not involving ring
A2 – stable, minimally displaced ring #
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Type B – Rotation unstable, Vertical stable
B1 – open book
B2 – lateral compression: ipsilateral
B3 – lateral compression: contralateral
B1 B2
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Type C – Rotation & Vertically unstable
C1 – Vertical shear
C2 – bilateral vertical shear
C3 – a/w acetabular #
C1
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THANK YOU
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