Early Management of Pelvic Ring Disruption

Question 1

How can open fractures occur in relation to the rectum and genitourinary systems?

Answer 1

perforation of the rectum and genitourinary systems

Question 2

What examination is necessary for women with suspected open fractures

Answer 2

A speculum examination

Question 3

open fractures Tx ?

Answer 3

antibiotics within 1 hour
First-generation cephalosporins
ADD Gram-negative coverage large degloving injuries or wounds that communicate with the bowel
Small lacerations irrigated and closed
larger wounds may require operative exploration
packing open wound performed before applying binder

Question 4

extremity traction ?

Answer 4

realigning anatomy
decreasing bleeding
reducing pain
beneficial for definitive treatment
skeletal traction pins placed in the distal femur, proximal or distal tibia, or calcaneus.

Question 5

What alternatives exist if skeletal traction is not possible?

Answer 5

manual traction during binder application, internal rotation of the extremities, and taping the toes together.

Question 6

risks of continued use of a CPAS or binder beyond 24 hours

Answer 6

obscure femoral access, impede abdominal access, and cause skin necrosis

Question 7

How should removal of the CPAS or binder be performed

Answer 7

ideally in the ICU, with the binder removed slowly and left in place beneath the patient for rapid reapplication if needed.(Hypotension)

Question 8

When is pelvic angiography indicated

Answer 8

persistent arterial bleeding
unresponsive to resuscitative efforts
have a binder or external fixation in place
and do not require surgical hemorrhage control.

Question 9

hen should pelvic packing be considered

Answer 9

when retroperitoneal hemorrhage is suspected
patient is unresponsive to binder
and primary resuscitation with intravenous fluids and blood.

Question 10

Why is understanding the pathoanatomy of pelvic hemorrhage important for pelvic packing?

Answer 10

because retroperitoneal veins in the space of Retzius and retroperitoneum are responsible for much of the pelvic hemorrhage

Question 11

How is pelvic packing performed?

Answer 11

Three pads are forcibly packed on each side: along the pelvic brim, into the true pelvis, and posteriorly near the sacroiliac joint.

pelvis must be stabilized with a binder or an external fixator

Question 12

What are the characteristics of an APC1 injury?

Answer 12

minimal anterior widening at the symphysis or anterior pelvis with insignificant ligamentous or bony disruption

Question 13

What identifies an APC2 injury, and what structures are disrupted?

Answer 13

> 2.5 cm of anterior symphysial widening
disruption of the sacrospinous
sacrotuberous
anterior sacroiliac ligaments

the posterior sacroiliac ligaments remain intact.

Question 14

What are the characteristics of an APC3 injury?

Answer 14

rupture of all anterior and posterior pelvic ligaments, gross instability of one or both hemipelves
significant intrapelvic hemorrhage
need for immediate intervention.

Question 15

What is indicated in the initial resuscitation of all APC injuries?

Answer 15

A binder

Question 16

What are the characteristics of an LC1 injury?

Answer 16

the sacral foramen or ala
anterior fractures of the superior and inferior rami
internal rotation of one hemipelvis.
common in the elderly after a fall from standing.

Question 17

What are the characteristics of an LC2 injury?

Answer 17

posterior fractures through the iliac wing
anterior fractures of the rami.

Question 18

LC3 injury, and why is it known as the “wind-swept” pelvis?

Answer 18

internal rotation of one hemipelvis
external (AP-type) rotation of the opposite hemipelvis, creating the “wind-swept” appearance.
These injuries have the greatest instability.

Question 19

How common is distal displacement in VS fractures,

Answer 19

very rare but is associated with significant nerve injury

Question 20

proximal vertical displacement in VS fractures?

Answer 20

vascular injury and soft tissue damage to the iliolumbar ligaments
anterior and posterior sacroiliac ligaments
anterior pelvic ligaments

Question 21

How is pelvic hemorrhage managed in patients with VS fractures?

Answer 21

Longitudinal traction on the shortened limb and binder application

Question 22

When does external fixation have a significant role

Answer 22

after 24 hours, typically when the patient can be transported to the operating room

Question 23

What is the preferred method of external fixation for pelvic fractures?

Answer 23

supra-acetabular two-pin external fixation

Question 24

When is external fixation preferred over internal fixation

Answer 24

when prior surgery or radiation complicates anterior open approaches
when there is an open fracture or gross contamination
or when other surgical incisions make standard approaches difficult.