Image of the Day 8: Open Book Fracture by: Muhamad Na’im Ab Razak (M.D USM)As the title speaks for itself, todays image of the day will briefly highlight about open bookfracture. Generally, pelvic fracture occurs as a result of high energy injuries and often involveother organ or system.Associated injury to the head, chest and abdomen should be look for. Apart from that, softtissue injury, hemorrhagic shock (from exposed fracture, vein and artery), urethral injury,fracture dislocation of adjacent bone or joint, neurovascular injury and lumbosacral nerveinjury should always be anticipatedFor example in this patient who is a 40 years old gentleman who trap inside his tractor when itfall from three meters height also sustains blunt cardiac injury, unstable left hip dislocationand intra abdominal injury.While stabilization taking place in emergency department, management of this patientrequires multi disciplinary approach especially, orthopedic, surgical, medical andanesthesiologist. Early intervention may save life and reduce the morbidity of the patient. AP view pelvic plain radiograph shows completely disruption of pubic tubercle
Stabilization of pelvic fracture with External fixator. previously, conservative management isthe preferred management but with the advance in orthopedic surgery, one may also considerinternal fixation.For more understanding regarding pelvic fracture, read this two articles in Medscape1) Pelvic fracture [link]2) Pelvic fracture in Emergency Medicine [link]
And this is the ECG of this patient which shows deep S wave, ST elevation and tall butnarrow T wave in lead V1 till lead V5. His blood cardiac enzyme marker also risessignificantly.