A 30-year-old Thai man was brought to the emergency room 15 minutes after a motor vehicle accident. He was unresponsive with a blood pressure of 80/50 mmHg and pulse of 120/min. A pelvic compression test was positive and his right leg was 3 cm shorter. Initial management included resuscitation with Ringer's lactate and oxygen, monitoring of vital signs, and pain control. Imaging found a fracture of the right pubic rami and left sacrum. The pelvic fracture was classified as Type B or C, indicating rotational and vertical instability. Management included immobilization with a pelvic binder and potential open reduction and internal fixation surgery.

1. Case discussion
Emergency conditions in orthopaedic
Group 1
Rotate 503-504
Faculty of Medicine Siriraj Hospital,Mahidol University

2. Pelvic injury with hypovolumic shock
ผู้ป่วยชายไทยอายุ 30 ปี ประสบอุบัติเหตุจราจร 15 นาที ก่อนมา
โรงพยาบาล ไม่รู้สึกตัว ตรวจร่างกาย BP 80/50 mmHg pulse 120/min
pelvic compression test +ve ขาขวาสั้นกว่าอีกข้าง 3 ซม.

3. Initial management
• Primary survey
• Resuscitation
– Ringer lactate solution
– Oxygen supplement : Mask with bag 10 LPM
• Monitor
– Vital sign
– Retain foley’s catheter  observe bleeding per
meatus before catheterize
• Pain control

4. Investigation
• FAST
• Blood for CBC, Coagulogram, G/M ,Hct stat
• Film pelvis AP
Fracture of right both pubic rami and left side of
sacrum
• Film pelvis inlet,outlet
• CT, CTA if vital signs unstable after sufficient
resuscitation

5. Physical Examination
• Asymmetrical legs (≥ 2cm)
• Urogenital examination : gross hematuria
• Pelvic compression test positive (AP, Lat.)
• Neurovascular injury
- lower extremities pulse
- neurological examination : DRE, DTR
Pelvic fracture

6. Modified Tile AO Müller classification
• Type A: stable - posterior arch is intact
• Type B: rotationally unstable, vertically stable -
incomplete disruption of the posterior arch
• Type C: rotationally and vertically unstable -
complete disruption of the posterior arch
Type B, Type C  Unstable pelvic fracture

7. Young-Burgess Classification
• Anterior Posterior Compression (APC)
• Lateral Compression (LC)
• Vertical Shear (VS)

9. Management
• immobilization of fractures
• Pelvic binder (tamponade effect)
• Closed reduction and external fixation
– C clamp, Distal femoral traction
• Set OR for open reduction and internal
fixation (definite treatment)

10. Thank you 