The pelvis has no inherent stability due to its ring-like bone structure connected by ligaments. Pelvic trauma can cause life-threatening bleeding due to proximity to major blood vessels in the highly vascularized bone. Classification systems categorize fractures by stability and force. For unstable fractures with hemorrhage, initial management includes aggressive resuscitation, provisional stabilization techniques like pelvic binding or C-clamps, and potential angiography or surgery to control bleeding. Early recognition and stabilization are crucial for survival in hemodynamically unstable patients with pelvic fractures.
5. Important Structures in Pelvis
• Urogenital system
• Digestive system
• Nerve system
• Vascular system
6. Pelvic Trauma
• High association with other injuries
• Major external forces required
• Proximity to major vessels
• Highly vascularized cancellous bone
8. Pelvic Fractures
• Integrity and stability of pelvic ring
are essential
• Pelvic fracture : disruption of pelvic
ring
• Mechanical instability vs
hemodynamic instability
• With / without visceral, vascular or
neurological injuries
• Pelvic fractures with hemodynamic
instability can be life threatening
9. Mechanism of injuries
• Motor vehicle accidents
• Falls
• Crushing injuries
• Working forces :
– Lateral compression
– AP compression
– Vertical shears
– Combined
10. Minor Pelvic Fractures
• Pelvic ring is still stable
• No damage to the major intrapelvic
structures
11. Major Pelvic Fractures
• Displacement of part of the pelvis
• Diastasis of the pelvis, disruption of
sacro-iliac joints, severe bleeding and
upward displacement of the pelvis
12. Complication of pelvic
fracture
• Rupture of the bladder
• Rupture of the urethra
• Sciatic nerve lesion
• Lumbosacral plexus damage
• Major vessel damage
• Massive retroperitoneal haemorrhage
• Paralytic ileus
• Intestinal and rectal damage
13. Pelvic Fracture Classification
• Many classifications
• AO/OTA, Tile, Young & Burgess
• Based on the concept of stability, force
direction and pathoanatomy
• Guide to treatment and allow centres to
compare results of similar cases
38. • Internal fixation of major pelvic
fractures in haemodynamic
unstable patient is contra
indicated
39. Summary
• Disruption of the pelvic ring integrity
may cause mechanical instability of the
pelvis
• Gross mechanical instability may be
associated with hemodynamic
instability
• Be aware of associated injuries
• Aggressive resuscitation and early
stabilization are mandatory in
haemodynamically unstable patient