2.  33 yo male construction
worker p/w extreme pain
to the right pelvis and
lower back s/p fall from
20 feet off a scaffolding
and landing on fully
extended right leg. Pt
had questionable LOC.
Otherwise no other pain
 T 98.5 P 120 BP 107/50 O2






98%
Gen: severe distress,
diaphoretic
CV: Tachycardic, RR, no
m/r/g
Pulm: Lungs CTA bilat
GI: s/nt/nd
Ext: right leg shortened
with pain on ROM.
GU: blood at urethral
meatus

5.  ATLS:
 A,B,Cs with IV, O2, Cardiac Monitor
 Address Hemorrhage
 Type/Cross for 6 U PRBC
 Immobilization of Pelvis
 Trauma imaging
 Emergent Orthopedic Consult

6.  Most concerning is significant hemorrhage (7-8 U
PRBC) into retroperitoneum:
 Internal iliac branches a.
 Superior gluteal a.
 Sacral venous plexus
  may require Angiography
 Assess for concomitant intra-abdominal trauma
 Consider GU trauma

7.  Posterior:
 Ilium, sacrum, SI
 Anterior:
 Symphysis pubis or pubic rami
 Vertically oriented anterior and posterior pelvis
 Complete Pelvic Floor + posterior SI + sacrospinous
and sacrotuberous ligaments
 Post. Sacroiliac ligaments  Vertical Stability
 Unstable Fractures!

9.  http://lifeinthefastlane.com/education/who-
was/eponymous-fractures/
 http://online-media.unimarburg.de/radiologie/kap12.htm
 http://www.wheelessonline.com/ortho/malgaigne_fra
cture_vertical_shear
 Simon, Robert, and Scott Sherman. Emergency
Orthopedics. New York: McGraw Hill, 2011. 6th Ed.