a simple way of describing pelvic injuries

1. PELVIC INJURIES

2. DEFINITION
 Injuries or fractures that involve the pelvis
bone and structure
 Why important?
 Highest mortality in pelvic fractures
 Rates can reach 20%
 Amount of force causing unstable pelvic fractures
also causes severe organ damage

3. When to suspect…
High velocity MVA (eg…)

4. Obvious wounds…
Severe hypovolemic
shock (class II and above)

5. When to suspect… (subtle signs)
Bruises around
flank or pelvis

6. Haematuria

7. If suspect pelvic injury…
Disrupts
pelvic ring
Not disrupting
pelvic ring

8. Pelvic ring

9. Injuries disrupting the pelvic ring

10. Open book fracture
Vertical shear fracture

11. Injuries not disrupting pelvic
ring
Pubic rami fractures
Iliac wing fractures

12. What is most important?
HYPOVOLEMIC SHOCK!

13. Why it bleeds so much?
Pre-sacral venous plexus
overlies the SI joint
Fracture disrupts SI joint
Tears the veins
BLEEDS!

14. Pelvis forms a limited
container
Disrupted pelvic ring
opens this container
Haemorrhage leaks into
retroperitoneum
MASSIVE BLEED
(5-6 LITRES)

15. What to do?
 A&E level
 Follow ATLS protocol (ABCDE)
 Most important to fluid resuscitate
 As massive bleeding suspected – blood
must be transfused (volume expanders
while waiting blood)
 Application of temporary pelvic
stabilizer (binder / c-clamp)

16. Pelvic binder

17. C-clamp

18. What to do?
 Orthopaedic role
 To decrease pelvis volume by
stabilizing with external fixators
 Why? – to contain the
haemorrhage
 Bleeding will stop due to
TEMPONADE effect

19. How to do?
 Pin placement:
 2cm posterior to ASIS along iliac crest
 Reduction:
 If open book – internal rotate the hip
 If vertical shear – traction through a supracondylar
pin 1st
 Hold:
 At least 2 bars must be clamped together

20. Pelvic # classification (Tile’s)
 Type A – STABLE
 A1 – # not involving ring
 A2 – stable, minimally displaced ring #

21.  Type B – Rotation unstable, Vertical stable
 B1 – open book
 B2 – lateral compression: ipsilateral
 B3 – lateral compression: contralateral
B1 B2

22.  Type C – Rotation & Vertically unstable
 C1 –Vertical shear
 C2 – bilateral vertical shear
 C3 – a/w acetabular #
C1

23. THANK YOU