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Pelvic injuries trauma 2012

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Ahmad Sulong

This document discusses pelvic injuries, which involve fractures of the pelvis bone. Pelvic fractures can be life-threatening due to the risk of severe bleeding, with mortality rates as high as 20% for unstable fractures. The most important concern in pelvic fractures is hypovolemic shock from massive blood loss, as disrupted pelvic fractures can tear venous structures and allow blood to accumulate in the retroperitoneum in volumes of up to 5-6 liters. Initial management of pelvic fractures focuses on fluid resuscitation and blood transfusion according to ATLS protocols, as well as application of a pelvic binder or C-clamp to stabilize the pelvis and reduce bleeding. Definitive treatment may involve external

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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 hypovolemic shock (class II and above)
When to suspect… (subtle signs) Bruises around flank or pelvis
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 supracondylar pin 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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Pelvic injuries trauma 2012

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Pelvic injuries trauma 2012

  • 2. 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
  • 3. When to suspect… High velocity MVA (eg…)
  • 4. Obvious wounds… Severe hypovolemic shock (class II and above)
  • 5. When to suspect… (subtle signs) Bruises around flank or pelvis
  • 7. If suspect pelvic injury… Disrupts pelvic ring Not disrupting pelvic ring
  • 10. Open book fracture Vertical shear fracture
  • 11. Injuries not disrupting pelvic ring Pubic rami fractures Iliac wing fractures
  • 12. What is most important? HYPOVOLEMIC SHOCK!
  • 13. Why it bleeds so much? Pre-sacral venous plexus overlies the SI joint Fracture disrupts SI joint Tears the veins BLEEDS!
  • 14. Pelvis forms a limited container Disrupted pelvic ring opens this container Haemorrhage leaks into retroperitoneum MASSIVE BLEED (5-6 LITRES)
  • 15. 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)
  • 18. 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
  • 19. 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 supracondylar pin 1st  Hold:  At least 2 bars must be clamped together
  • 20. Pelvic # classification (Tile’s)  Type A – STABLE  A1 – # not involving ring  A2 – stable, minimally displaced ring #
  • 21.  Type B – Rotation unstable, Vertical stable  B1 – open book  B2 – lateral compression: ipsilateral  B3 – lateral compression: contralateral B1 B2
  • 22.  Type C – Rotation & Vertically unstable  C1 –Vertical shear  C2 – bilateral vertical shear  C3 – a/w acetabular # C1