pelvic injuries trauma 2012

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

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