Chapter 5 - Abdominal And Pelvic Injuries

Question 1

Clinical signs suggestive of a fractured pelvis

Answer 1

Urethral injury - blood at the EUM
Scrotal hematoma
Limb length discrepancy
Rotational deformity of the leg
Tenderness on gentle palpation

DO NOT MANIPULATE - MAY DISLODGE CLOT

Question 2

Where should a pelvic binder be positioned?

Answer 2

Centered over the greater trochanters

Question 3

Clinical signs suggestive of urethral injury

Answer 3

Blood at the EUM

Scrotal or perineal hematoma or ecchymosis

Question 4

Clinical signs suggestive of urethral injury

Answer 4

Blood at the EUM

Scrotal or perineal hematoma or ecchymosis

Question 5

Gold standard investigation for urethral injury

Answer 5

Retrograde urethrogram

Question 6

Indications for retrograde urerhrogram

Answer 6

Blood at EUM
Scrotal or perineal ecchymosis or hematoma
Unable to void
Pelvic fracture

Question 7

1. 1. List 4 regions examined by FAST

1. 2. List the indications for FAST

Answer 7

1.1.
 Pericardial sac
Hepatorenal fossa
Splonorenal fossa
Pelvic or pouch of Douglas

Question 8

Pelvic fractures are classified into 4 types based on their injury force patterns

Answer 8

AP compression
Lateral compression
Vertical shear
Combined mechanism

Question 9

Mortality for patients with pelvic fractures are 1 in 6 (range 5-30%) and increases to 1 in 4 with closed pelvic fractures with hypotension.

Open pelvic fractures - 50% mortality

List the associated injuries with each pelvic fracture mechanism

Answer 9

1.1. AP compression

Teraing of posterior venous plexus
Iliac vessel injury
Disruption of the sacroiliac, sacrospinous and sacrotuberous ligaments

1.2. Lateral compression

Gebitourinary injuries
Vascular injuries less significant

1.3. Vertical shear - fall >3.5m

Disruption of the sacroiliac, sacrospinous and sacrotuberous ligaments
Iliac vessel injury