The document discusses pelvic fractures, including: - Pelvic fractures can range from benign to life-threatening and are often associated with other injuries. - They are commonly caused by high-energy blunt trauma like motor vehicle accidents. - Classification systems include the Young and Burgess system (based on mechanism of injury) and the Tile system (based on stability). - Treatment depends on the classification but may include hemorrhage control, pelvic binding, angiography, surgery, and fixation devices. Complications can include blood loss, nerve injury, and infection.

1. PELVIC FRACTURES
Dr. Raman Ghimire
2018/01/16 Pelvic Fractures

2. Overview
• Introduction
• Epidemiology
• Etiology
• Relevant anatomy
• Classification
• Approach to Polytrauma
• Complications
• Take home messages
• MCQs
• References
2018/01/16 Pelvic Fractures

3. Introduction
• Pelvic fracture is a disruption of the bony structure of the pelvis, including the hip
bone, sacrum and coccyx.
• Benign to life threatening
• Component of Polytrauma , associated injuries :
 Chest injuries (63%)
 Long bone fractures (50%)
 Head injury (40%)
 Solid organ injury (40%)
 Intestinal injuries (14%)
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4. Epidemiology
• Incidence : 23 per 100,000 persons per year
• Age : 15-28 years
• Male <35 years , Female >35 years
• 3 percent of skeletal injuries
• Open pelvic fractures: 2 – 4%
• Mortality:5 -16 %
(unstable pelvic fractures:8 %)
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5. Etiology
• High energy blunt trauma
 RTA: 80 - 84% of pelvic fractures
 Falls from height: 5 -12%
 Young people
 Abdominal and pelvic visceral injury
• Low energy mechanism
 Fall from standing height
 Old people
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6. Relevant Anatomy
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7. Stability of Pelvis
• Pelvic ring
Strength of ring:
40% anterior
60% posterior
• Ligaments
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8. Ligaments
Posterior ligaments are stronger than anterior (Sacroiliac strongest)
Transverse: resist rotational force
Longitudional : resist vertical shear
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9. Vessels
Bleeding commonly from
venous plexus
 Blood loss :
Pelvic fracture : 1500-2000 ml
Femur fracture: 1000-1500ml
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10. Nerves
L5 –S1 nerve roots are commonly injured
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11. Visceral Anatomy
Bladder injury: 16% urethral 7%
Common with APC injury
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12. Classification
1. Young and Burgess Classification
2. Tile Classification
3. Apley ‘s Classification
4. Academy of Orthopedics/Orthopedic Trauma Association
classification system (AO/OTA) : Research
5. Denis zone of classification : sacral injury
6. Jones-Powell Classification : open pelvic fractures
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13. Young and Burgess Classification
(mechanism of injury)
• Lateral compression (LC)
• Anteroposterior compression (APC)
• Vertical shear (VS)
• Combined mechanism (CM)
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14. LC
APC
VS
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15. Tile Classification (stability)
TILE A : stable
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16. TILE B: rotationally unstable/vertically stable
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17. TILE C: rotationally and vertically unstable
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18. APPROACH TO POLYTRAUMA
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19. Primary Survey and Resuscitation
• Airway Maintenance with C-spine protection
• Breathing and ventilation
• Circulation with hemorrhage control
Start 2 Large Bore IV Lines
Infuse Crystalloids 2 to 3 Litres ; Blood transfusion
• Disability: Neurologic status ; AVPU
• Exposure –undress patient but prevent hypothermia
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21. Diagnostic tools
• CXR-AP
• X-ray C-spine- Lateral
• X-ray Pelvis-AP
• FAST scan
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22. Hemorrhage control in pelvic fracture
• Pelvic Containment
– Sheet
– Pelvic Binder
– External Fixation
• Angiography and embolization
• Laparotomy
• Pelvic Packing
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23. Circumferential Sheeting Pelvic binder
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24. 2018/01/16 Pelvic Fractures
widening of symphysis pubis & sacroiliac joint.
displaced fracture of the right femoral shaft .
APC injury (open book)
S/P pelvic binder application

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26. Secondary Survey
• DOES NOT BEGIN UNTIL
 Primary Survey( ABCDEs) is completed,
 Resuscitative efforts are well established
 Normalisation of vital functions
• INCLUDES:
 Head to toe evaluation
 History
Reassessment of all vital organs
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27. Examination of pelvis (secondary survey)
• Open wounds
• Limb shortening and rotation
• Swelling & hematoma
• Bleeding Per urethra , high riding prostate
• Pelvic compression test
• Roux's sign: decreased distance from greater trochanter to pubic tubercle
• Earle's sign: hematoma or bony prominence and tenderness on rectal examination
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29. Investigations
• X-ray:
 Standard AP
Inlet view,
Outlet view
Judet view
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32. Radiographic signs of instability
• > 5 mm displacement of posterior sacroiliac complex
• Avulsion fractures of:
 ischial spine
 ischial tuberosity
 sacrum
 transverse process of 5th lumbar vertebrae
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33. • CT-scan
posterior injury
3D reconstruction
CT 3D Reconstruction- APC 3
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34. • Hb/ PCV
• Retrograde urethrography
• cystography
• IV urogram
• Angiography
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35. Non Operative Management
• Pain management
• Protected weight bearing with crutch or walker
• Serial x-ray to look for instability
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36. Operative Management
• External Fixator
• ORIF with screws and plate
• Iliosacral screws
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37. Complications
• Hemorrhage– shock
• Nerve injury
• Fat embolism
• Infection
• DVT
• Non Union
• Malunion
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38. Take Home Messages
• Tile and Burgess & Young Classifications are the most commonly used
classifications
• Follow ATLS protocol : ABCDE
• Systematic well-organized multidisciplinary approach needed for management.
• Ilium- Part of hip bone
Ileum-Part of small intestines
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39. MCQs
1.All of the following areas are commonly involved sites in pelvic fracture except:
A. Pubic rami
B. Alae of ilium
C. Acetabulum
D. Ischial tuberosities
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40. 2. Which of the following is commonly injured with pelvic fracture :
A. urethra
B. bladder
C. prostate
D. rectum
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41. 3 .Death 3 days after pelvic fracture is most likely to be due to:
A Haemorrhage
В Pulmonary embolism
С Fat embolism
D Respiratory distress
E Infection.
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42. REFERENCES
• Campbell's operative orthopaedics 13th edition
• Apley's System of Orthopaedics and Fractures, 9th Edition
• Rockwood and green's fractures in adults 8th edition
• Uptodate
• Medscape
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43. THANK YOU
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