pelvic ring initial management and evaluation -...
TRANSCRIPT
![Page 1: Pelvic ring initial management and evaluation - ao-danmark.dkao-danmark.dk/wp-content/uploads/2016/04/O8JB.pdf · •Ved åbne fraktur •Effektiv fortil (open book) •Stabiliserer](https://reader031.vdocuments.mx/reader031/viewer/2022022803/5c80ee4009d3f263728b84d3/html5/thumbnails/1.jpg)
Jeppe Barckman
Ortopædkirurgisk afd.
Aarhus Universitetshospital
Pelvic ring
initial management and evaluation
![Page 2: Pelvic ring initial management and evaluation - ao-danmark.dkao-danmark.dk/wp-content/uploads/2016/04/O8JB.pdf · •Ved åbne fraktur •Effektiv fortil (open book) •Stabiliserer](https://reader031.vdocuments.mx/reader031/viewer/2022022803/5c80ee4009d3f263728b84d3/html5/thumbnails/2.jpg)
![Page 3: Pelvic ring initial management and evaluation - ao-danmark.dkao-danmark.dk/wp-content/uploads/2016/04/O8JB.pdf · •Ved åbne fraktur •Effektiv fortil (open book) •Stabiliserer](https://reader031.vdocuments.mx/reader031/viewer/2022022803/5c80ee4009d3f263728b84d3/html5/thumbnails/3.jpg)
![Page 4: Pelvic ring initial management and evaluation - ao-danmark.dkao-danmark.dk/wp-content/uploads/2016/04/O8JB.pdf · •Ved åbne fraktur •Effektiv fortil (open book) •Stabiliserer](https://reader031.vdocuments.mx/reader031/viewer/2022022803/5c80ee4009d3f263728b84d3/html5/thumbnails/4.jpg)
• Akut behandling
• Anatomi
• Rtg. / CT
• Klassificering/vurdering
• Take home message
Disposition
![Page 5: Pelvic ring initial management and evaluation - ao-danmark.dkao-danmark.dk/wp-content/uploads/2016/04/O8JB.pdf · •Ved åbne fraktur •Effektiv fortil (open book) •Stabiliserer](https://reader031.vdocuments.mx/reader031/viewer/2022022803/5c80ee4009d3f263728b84d3/html5/thumbnails/5.jpg)
• Modtages efter ATLS
princip.
Ustabil patient med
bækkenfraktur
![Page 6: Pelvic ring initial management and evaluation - ao-danmark.dkao-danmark.dk/wp-content/uploads/2016/04/O8JB.pdf · •Ved åbne fraktur •Effektiv fortil (open book) •Stabiliserer](https://reader031.vdocuments.mx/reader031/viewer/2022022803/5c80ee4009d3f263728b84d3/html5/thumbnails/6.jpg)
• Modtages efter ATLS
princip.
• Ved mistanke om
blødning fra bækkenet
PLAN
Ustabil patient med
bækkenfraktur
![Page 7: Pelvic ring initial management and evaluation - ao-danmark.dkao-danmark.dk/wp-content/uploads/2016/04/O8JB.pdf · •Ved åbne fraktur •Effektiv fortil (open book) •Stabiliserer](https://reader031.vdocuments.mx/reader031/viewer/2022022803/5c80ee4009d3f263728b84d3/html5/thumbnails/7.jpg)
Blødning
Mekanisk stabilisering
– Mindske volumen
– Mindske blødning fra
frakturflader
Hæmodynamisk stabilisering
– Erstatte blodtab
– Kontrollere blødning
Ustabil patient med
bækkenfraktur
![Page 8: Pelvic ring initial management and evaluation - ao-danmark.dkao-danmark.dk/wp-content/uploads/2016/04/O8JB.pdf · •Ved åbne fraktur •Effektiv fortil (open book) •Stabiliserer](https://reader031.vdocuments.mx/reader031/viewer/2022022803/5c80ee4009d3f263728b84d3/html5/thumbnails/8.jpg)
Mekanisk stabilisering
Bækkenslynge
• Hurtig (få minutter)
• Simpel teknik
• Placeres over trochanter
Before
After
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• Ved åbne fraktur
• Effektiv fortil (open
book)
• Stabiliserer ikke bagtil
• Langsom (½-1 time)
Mekanisk stabilisering
Ekstern fiksation
![Page 10: Pelvic ring initial management and evaluation - ao-danmark.dkao-danmark.dk/wp-content/uploads/2016/04/O8JB.pdf · •Ved åbne fraktur •Effektiv fortil (open book) •Stabiliserer](https://reader031.vdocuments.mx/reader031/viewer/2022022803/5c80ee4009d3f263728b84d3/html5/thumbnails/10.jpg)
Ex-fix pelvis
![Page 11: Pelvic ring initial management and evaluation - ao-danmark.dkao-danmark.dk/wp-content/uploads/2016/04/O8JB.pdf · •Ved åbne fraktur •Effektiv fortil (open book) •Stabiliserer](https://reader031.vdocuments.mx/reader031/viewer/2022022803/5c80ee4009d3f263728b84d3/html5/thumbnails/11.jpg)
Ca. 25
grader
ckranielt og
medialt
Ex-fix pelvis
![Page 12: Pelvic ring initial management and evaluation - ao-danmark.dkao-danmark.dk/wp-content/uploads/2016/04/O8JB.pdf · •Ved åbne fraktur •Effektiv fortil (open book) •Stabiliserer](https://reader031.vdocuments.mx/reader031/viewer/2022022803/5c80ee4009d3f263728b84d3/html5/thumbnails/12.jpg)
Tear - drop
Teardrop repræsenter
denne ”ben tunel”
![Page 13: Pelvic ring initial management and evaluation - ao-danmark.dkao-danmark.dk/wp-content/uploads/2016/04/O8JB.pdf · •Ved åbne fraktur •Effektiv fortil (open book) •Stabiliserer](https://reader031.vdocuments.mx/reader031/viewer/2022022803/5c80ee4009d3f263728b84d3/html5/thumbnails/13.jpg)
![Page 14: Pelvic ring initial management and evaluation - ao-danmark.dkao-danmark.dk/wp-content/uploads/2016/04/O8JB.pdf · •Ved åbne fraktur •Effektiv fortil (open book) •Stabiliserer](https://reader031.vdocuments.mx/reader031/viewer/2022022803/5c80ee4009d3f263728b84d3/html5/thumbnails/14.jpg)
Mekanisk stabilisering
C-clamp
• Posterior kompression
• Vanskelig
![Page 15: Pelvic ring initial management and evaluation - ao-danmark.dkao-danmark.dk/wp-content/uploads/2016/04/O8JB.pdf · •Ved åbne fraktur •Effektiv fortil (open book) •Stabiliserer](https://reader031.vdocuments.mx/reader031/viewer/2022022803/5c80ee4009d3f263728b84d3/html5/thumbnails/15.jpg)
Hæmodynamisk stabilisering
Bækkenpakning
![Page 16: Pelvic ring initial management and evaluation - ao-danmark.dkao-danmark.dk/wp-content/uploads/2016/04/O8JB.pdf · •Ved åbne fraktur •Effektiv fortil (open book) •Stabiliserer](https://reader031.vdocuments.mx/reader031/viewer/2022022803/5c80ee4009d3f263728b84d3/html5/thumbnails/16.jpg)
Hæmodynamisk stabilisering
Embolisering
Evt.
![Page 17: Pelvic ring initial management and evaluation - ao-danmark.dkao-danmark.dk/wp-content/uploads/2016/04/O8JB.pdf · •Ved åbne fraktur •Effektiv fortil (open book) •Stabiliserer](https://reader031.vdocuments.mx/reader031/viewer/2022022803/5c80ee4009d3f263728b84d3/html5/thumbnails/17.jpg)
Anatomi - Knogler
• Ingen ossiøs
stabilitet
• Stabiliseres af
symfysen og
ligamenter
![Page 18: Pelvic ring initial management and evaluation - ao-danmark.dkao-danmark.dk/wp-content/uploads/2016/04/O8JB.pdf · •Ved åbne fraktur •Effektiv fortil (open book) •Stabiliserer](https://reader031.vdocuments.mx/reader031/viewer/2022022803/5c80ee4009d3f263728b84d3/html5/thumbnails/18.jpg)
Anatomi - Ligamenter
![Page 19: Pelvic ring initial management and evaluation - ao-danmark.dkao-danmark.dk/wp-content/uploads/2016/04/O8JB.pdf · •Ved åbne fraktur •Effektiv fortil (open book) •Stabiliserer](https://reader031.vdocuments.mx/reader031/viewer/2022022803/5c80ee4009d3f263728b84d3/html5/thumbnails/19.jpg)
Anatomi - Ligamenter
![Page 20: Pelvic ring initial management and evaluation - ao-danmark.dkao-danmark.dk/wp-content/uploads/2016/04/O8JB.pdf · •Ved åbne fraktur •Effektiv fortil (open book) •Stabiliserer](https://reader031.vdocuments.mx/reader031/viewer/2022022803/5c80ee4009d3f263728b84d3/html5/thumbnails/20.jpg)
Rtg
![Page 21: Pelvic ring initial management and evaluation - ao-danmark.dkao-danmark.dk/wp-content/uploads/2016/04/O8JB.pdf · •Ved åbne fraktur •Effektiv fortil (open book) •Stabiliserer](https://reader031.vdocuments.mx/reader031/viewer/2022022803/5c80ee4009d3f263728b84d3/html5/thumbnails/21.jpg)
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Rtg / CT
![Page 23: Pelvic ring initial management and evaluation - ao-danmark.dkao-danmark.dk/wp-content/uploads/2016/04/O8JB.pdf · •Ved åbne fraktur •Effektiv fortil (open book) •Stabiliserer](https://reader031.vdocuments.mx/reader031/viewer/2022022803/5c80ee4009d3f263728b84d3/html5/thumbnails/23.jpg)
Rtg / CT
![Page 24: Pelvic ring initial management and evaluation - ao-danmark.dkao-danmark.dk/wp-content/uploads/2016/04/O8JB.pdf · •Ved åbne fraktur •Effektiv fortil (open book) •Stabiliserer](https://reader031.vdocuments.mx/reader031/viewer/2022022803/5c80ee4009d3f263728b84d3/html5/thumbnails/24.jpg)
AP kompression Lateral kompression Vertical shear
Fraktur af bækkenringen
![Page 25: Pelvic ring initial management and evaluation - ao-danmark.dkao-danmark.dk/wp-content/uploads/2016/04/O8JB.pdf · •Ved åbne fraktur •Effektiv fortil (open book) •Stabiliserer](https://reader031.vdocuments.mx/reader031/viewer/2022022803/5c80ee4009d3f263728b84d3/html5/thumbnails/25.jpg)
Anterior Posterior Compression APC 1
Open book
• Ruptur af symfysen
• Sakrotuberale og sakrospinale
ligament intakt
![Page 26: Pelvic ring initial management and evaluation - ao-danmark.dkao-danmark.dk/wp-content/uploads/2016/04/O8JB.pdf · •Ved åbne fraktur •Effektiv fortil (open book) •Stabiliserer](https://reader031.vdocuments.mx/reader031/viewer/2022022803/5c80ee4009d3f263728b84d3/html5/thumbnails/26.jpg)
Anterior Posterior Compression APC 2
Open book
• Ruptur
– symfysen +
– sakrotuberale og sakrospinale
ligament +
– ant. SI ligament
![Page 27: Pelvic ring initial management and evaluation - ao-danmark.dkao-danmark.dk/wp-content/uploads/2016/04/O8JB.pdf · •Ved åbne fraktur •Effektiv fortil (open book) •Stabiliserer](https://reader031.vdocuments.mx/reader031/viewer/2022022803/5c80ee4009d3f263728b84d3/html5/thumbnails/27.jpg)
Anterior Posterior Compression APC 3
Open book
• Ruptur
– symfysen +
– sakrotuberale og sakrospinale
ligament +
– ant. SI ligament +
– post. SI ligament
![Page 28: Pelvic ring initial management and evaluation - ao-danmark.dkao-danmark.dk/wp-content/uploads/2016/04/O8JB.pdf · •Ved åbne fraktur •Effektiv fortil (open book) •Stabiliserer](https://reader031.vdocuments.mx/reader031/viewer/2022022803/5c80ee4009d3f263728b84d3/html5/thumbnails/28.jpg)
Ustabil bækken?
![Page 29: Pelvic ring initial management and evaluation - ao-danmark.dkao-danmark.dk/wp-content/uploads/2016/04/O8JB.pdf · •Ved åbne fraktur •Effektiv fortil (open book) •Stabiliserer](https://reader031.vdocuments.mx/reader031/viewer/2022022803/5c80ee4009d3f263728b84d3/html5/thumbnails/29.jpg)
Lateral Compression
LCP 1
• Fraktur af ramus
• Partiel læsion af SI led
(kompression af sacrum)
![Page 30: Pelvic ring initial management and evaluation - ao-danmark.dkao-danmark.dk/wp-content/uploads/2016/04/O8JB.pdf · •Ved åbne fraktur •Effektiv fortil (open book) •Stabiliserer](https://reader031.vdocuments.mx/reader031/viewer/2022022803/5c80ee4009d3f263728b84d3/html5/thumbnails/30.jpg)
Lateral Compression
LCP 1
![Page 31: Pelvic ring initial management and evaluation - ao-danmark.dkao-danmark.dk/wp-content/uploads/2016/04/O8JB.pdf · •Ved åbne fraktur •Effektiv fortil (open book) •Stabiliserer](https://reader031.vdocuments.mx/reader031/viewer/2022022803/5c80ee4009d3f263728b84d3/html5/thumbnails/31.jpg)
Lateral Compression
LCP 2
• Fraktur i Ilium (Crescent frx.)
• OBS blære ruptur
![Page 32: Pelvic ring initial management and evaluation - ao-danmark.dkao-danmark.dk/wp-content/uploads/2016/04/O8JB.pdf · •Ved åbne fraktur •Effektiv fortil (open book) •Stabiliserer](https://reader031.vdocuments.mx/reader031/viewer/2022022803/5c80ee4009d3f263728b84d3/html5/thumbnails/32.jpg)
Lateral Compression
LCP 3
• Fraktur af ramus/symfyse
• Ilium + contra lat ”open book”
![Page 33: Pelvic ring initial management and evaluation - ao-danmark.dkao-danmark.dk/wp-content/uploads/2016/04/O8JB.pdf · •Ved åbne fraktur •Effektiv fortil (open book) •Stabiliserer](https://reader031.vdocuments.mx/reader031/viewer/2022022803/5c80ee4009d3f263728b84d3/html5/thumbnails/33.jpg)
Vertical Shear
• Komplet ruptur af SI ligamenter
• Alle typer af anterior læsion
• Læsion af bækkenbund
• Vertikal og rotatorisk instabil
![Page 34: Pelvic ring initial management and evaluation - ao-danmark.dkao-danmark.dk/wp-content/uploads/2016/04/O8JB.pdf · •Ved åbne fraktur •Effektiv fortil (open book) •Stabiliserer](https://reader031.vdocuments.mx/reader031/viewer/2022022803/5c80ee4009d3f263728b84d3/html5/thumbnails/34.jpg)
Vertical Shear
![Page 35: Pelvic ring initial management and evaluation - ao-danmark.dkao-danmark.dk/wp-content/uploads/2016/04/O8JB.pdf · •Ved åbne fraktur •Effektiv fortil (open book) •Stabiliserer](https://reader031.vdocuments.mx/reader031/viewer/2022022803/5c80ee4009d3f263728b84d3/html5/thumbnails/35.jpg)
Take home messages
Bækkenrings fraktur
Before After
• Modtages efter ATLS princip.
• Ved blødnings shock
– Mekanisk stabilisering
• Mindske volumen
• Mindske blødning fra frakturflader
![Page 36: Pelvic ring initial management and evaluation - ao-danmark.dkao-danmark.dk/wp-content/uploads/2016/04/O8JB.pdf · •Ved åbne fraktur •Effektiv fortil (open book) •Stabiliserer](https://reader031.vdocuments.mx/reader031/viewer/2022022803/5c80ee4009d3f263728b84d3/html5/thumbnails/36.jpg)
Take home messages
Bækkenrings fraktur
• Modtages efter ATLS princip.
• Ved blødnings shock
– Mekanisk stabilisering
• Mindske volumen
• Mindske blødning fra frakturflader
– Hæmodynamisk stabilisering
• Erstatte blodtab
• Kontrollere blødning