Pelvic Fractures

Question 1

What are the clinical signs/presentation for a patient with a pelvic fracture?

Answer 1

1. Relevant mechanism of injury
2. Ecchymosis, abrasions, haematomas, bleeding, haemorrhagic shock
3. Obvious pelvic & leg asymmetry or deformity
4. Focal tenderness to palpation, loss of movement / power
5. May see bladder / bowel incontinence & haemorrhage

Question 2

What are the 3 types of pelvic fractures?

Answer 2

1. Anterior Posterior Compression (APC)
   - car v pedestrian, pinned against wall etc
2. Lateral compression (LC)
   - lateral forces such as being t-boned by a vehicle
3. Vertical shear (VS)
   - associated with high-speed frontal RTCs due to patient bracing heavily with locked legs
   - likely to be associated with hip & femoral fractures + internal injury

Question 3

Outline the management principles for pelvic fractures.

Answer 3

1. Conduct usual trauma sequence - consider MILS
2. Control any obvious external haemorrhage
3. Look for asymmetry / leg rotation / shortening
4. Careful observation & assessment
5. Early SITREP & CCP backup
6. Large bore bilateral IV access - if hypotensive consider fentanyl for analgesia
7. Avoid hypothermia
8. Consider pelvic binder & traction splint - what will add most value??
9. Use very minimal movement log rolls to prevent clot disruption