pelvic injuries trauma 2012

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PELVIC INJURIES

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Page 1: Pelvic injuries trauma 2012

PELVIC INJURIES

Page 2: Pelvic injuries trauma 2012

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

Page 3: Pelvic injuries trauma 2012

When to suspect…

High velocity MVA (eg…)

Page 4: Pelvic injuries trauma 2012

Obvious wounds…Severe hypovolemicshock (class II and above)

Page 5: Pelvic injuries trauma 2012

Bruises around flank or pelvis

When to suspect… (subtle signs)

Page 6: Pelvic injuries trauma 2012

Haematuria

Page 7: Pelvic injuries trauma 2012

If suspect pelvic injury…

Disrupts pelvic ring

Not disrupting pelvic ring

Page 8: Pelvic injuries trauma 2012

Pelvic ring

Page 9: Pelvic injuries trauma 2012

Injuries disrupting the pelvic ring

Page 10: Pelvic injuries trauma 2012

Open book fracture

Vertical shear fracture

Page 11: Pelvic injuries trauma 2012

Injuries not disrupting pelvic ring

Pubic rami fractures

Iliac wing fractures

Page 12: Pelvic injuries trauma 2012

What is most important?

HYPOVOLEMIC SHOCK!

Page 13: Pelvic injuries trauma 2012

Why it bleeds so much?

Pre-sacral venous plexus overlies the SI joint

Fracture disrupts SI joint

Tears the veins

BLEEDS!

Page 14: Pelvic injuries trauma 2012

Pelvis forms a limited container

Disrupted pelvic ring opens this container

Haemorrhage leaks into retroperitoneum

MASSIVE BLEED (5-6 LITRES)

Page 15: Pelvic injuries trauma 2012

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)

Page 16: Pelvic injuries trauma 2012

Pelvic binder

Page 17: Pelvic injuries trauma 2012

C-clamp

Page 18: Pelvic injuries trauma 2012

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

Page 19: Pelvic injuries trauma 2012

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

Page 20: Pelvic injuries trauma 2012

Pelvic # classification (Tile’s)

Type A – STABLE

A1 – # not involving ring

A2 – stable, minimally displaced ring #

Page 21: Pelvic injuries trauma 2012

Type B – Rotation unstable, Vertical stable

B1 – open book

B2 – lateral compression: ipsilateral

B3 – lateral compression: contralateral

B1 B2

Page 22: Pelvic injuries trauma 2012

Type C – Rotation & Vertically unstable

C1 – Vertical shear

C2 – bilateral vertical shear

C3 – a/w acetabular #

C1

Page 23: Pelvic injuries trauma 2012

THANK YOU

Page 24: Pelvic injuries trauma 2012