Pelvic ring fractures
Background
Classification
Prognosis
High prevalence of poor functional outcomes and chronic pain
Haemorrhage is the leading cause of dealth
Associated injuries: urogenital injuries in 12-20% (especially males), other trauma related injuries also occur
Management
Anatomy
Displacement can only occur if the ring is disrupted in two places
In a trauma, 90% of blood loss occurs from the veins and 10% from the artery
The venous plexus run along the inside of the pelvic ring. In fractures these plexus' stretch with boney disruption leading to haemorrhage
The artery that is usually involved is the interior iliac artery
Clinical presentation
Mortality rate 15-25% for closed fractures, as much as 50% for open fractures
Young Burgess
First classifies fracture into 1 of three groups based on direction: AP compression, lateral compression or vertical shear
Secondly classifies APC's and LC's into three types based on degree of injury
Inspection: leg length discrepancy, signs of bleeding e.g. ecchymosis, haematoma, and lacerations
Movement: testing stability with gentle rotational force, external rotation of leg
+/- haemodynamic instability
Other exams: neuro (L5 (foot drop, paraesthesia down back+ medial foot), S1 (inability to lift heel, paraesthesia down back + lateral foot)), urogenital (vaginal, urethral), and abdo (rectal).
Inability to weight bear
Pain
Investigations
Trauma
Other
AP pelvis (symmetry, rotation, displacement)
Bloods: VBG, group and save/cross match, FBC, coags, BHCG
Fast scan +/- DPA to rule out false negative FAST scan
Other imaging pertinent to the trauma survey
X-ray: inlet + outlet views
CT +/- angiography
Trauma
Airway
Breathing
Circulation
Fluid resuscitation
Pelvic binder: over greater trochanter +/- internal rotation of lower limb with taping of ankles
Bloods
Definitive
Stable
Unstable
Operative: ORIF or anterior subcutaenous pelvic fixator
Non operative: weight bearing as tolerated
Initially
Packing (usually for venous bleeding)
Mechanical stabilisation by external fixation
Angiography with embolisation (usually for arterial bleeding)
Further management #
Mechanism of injury: high energy blunt trauma