Pelvic Fracture Flashcards
What is the pelvic ring?
Formed by two innominate bones (i.e. ilium, ischium and pubis) + the sacrum and supporting ligaments.
What does the true pelvis contain?
Female = Rectum, bladder and uterus + iliac vessels and lumbosacral nerve roots
Male = Rectum, bladder
Associated injuries of pelvic fractuers
Life-threatening haemorrhage
Neurological deficit
Urogenital trauma
Bowel injury
Mechanism of injury
Caused by both high and low energy trauma
Most common is high energy blunt trauma from RTAs or falls from height.
The damage occur either at bony or ligamentous points
Clinical features
Obvious deformity
Significant pain and swelling
Examination
Full neurovascular assessment
Check anal tone, sacral nerve roots and iliac vessels.
Also check for abdo injuries, urethral injuries and open fractures
Open fractures can also be internal meaning they go into rectum or vagina
Also check for ecchymosis and developing haematoma
Dx
Head, chest, spine and other bone fracture
Concurrent acetabular fractures can happen as well
What are low energy pelvic fractures?
Typically avulsion fractures if in young.
Sudden severe pain that is poorly localised to hip and pelvis.
The pain is felt while performing a rapid, powerful movement like starting to run.
Site most commonly affected are ASIS (sartorius), AIIS (rectus femoris) and ischial tuberosity (hamstring muscles).
How are low energy pelvic avulsion fractures treated?
Conservatively unless significantly displaced
Ix
Any patient with high-energy injury with suspected pelvic fracture must be assessed and managed as per ATLS guidelines.
Minimum of 3 plain film radiographs to assess the pelvic ring (AP, inlet view and outlet view)
CT scan is commonly performed in trauma setting instead.
Classification systems for pelvic ring injuries
Young and Burgess
Tile
Explain Young and Burgess classification
Based on the evctor of the disrupting force and the resulting degree of displacement
AP compression (1-3)
Lateral compression (1-3)
Vertical shear (1-2) Complete loss of attachment between sacrum and lower limb (uni (1), bilat (2))
Explain Tile classification
Based on stability of the pelvic ring
A-type = Rotationally and vertically stable
B-type = Horizontally unstable but vertically stable
C = Both horizontally and vertically unstable
What is the Denis classification?
To classify fractures of the sacrum
General management
Any patient with high energy trauma and suspected pelvic ring fracture should be managed by ATLS with resuscitation and stabilisation.
You should also get IV access and get bloods, clotting and Group and Save.
This is because pelvic injuries often follow with blood loss leading to hypovolaemic shock.
Any hypotensive patient with history of pelvic trauma should be assumed to have a pelvic fracture until proven otherwise.
A pelvic binder should be applied to give skeletal stabilisation
Full Young & Burgess classification
