A 33-year-old male construction worker presented with extreme pain in his right pelvis and lower back after falling 20 feet from scaffolding and landing on his fully extended right leg. He was tachycardic and diaphoretic. Examination found his right leg shortened with pain on range of motion and blood at the urethral meatus. Imaging revealed significant hemorrhage into the retroperitoneum likely from branches of the internal iliac artery, superior gluteal artery, or sacral venous plexus. He received intravenous fluids, oxygen, and a trauma workup. An orthopedic consult was emergently placed for possible unstable pelvic fractures requiring angiography.

2.  33 yo male construction
worker p/w extreme pain
to the right pelvis and
lower back s/p fall from
20 feet off a scaffolding
and landing on fully
extended right leg. Pt
had questionable LOC.
Otherwise no other pain
 T 98.5 P 120 BP 107/50 O2






98%
Gen: severe distress,
diaphoretic
CV: Tachycardic, RR, no
m/r/g
Pulm: Lungs CTA bilat
GI: s/nt/nd
Ext: right leg shortened
with pain on ROM.
GU: blood at urethral
meatus

5.  ATLS:
 A,B,Cs with IV, O2, Cardiac Monitor
 Address Hemorrhage
 Type/Cross for 6 U PRBC
 Immobilization of Pelvis
 Trauma imaging
 Emergent Orthopedic Consult

6.  Most concerning is significant hemorrhage (7-8 U
PRBC) into retroperitoneum:
 Internal iliac branches a.
 Superior gluteal a.
 Sacral venous plexus
  may require Angiography
 Assess for concomitant intra-abdominal trauma
 Consider GU trauma

7.  Posterior:
 Ilium, sacrum, SI
 Anterior:
 Symphysis pubis or pubic rami
 Vertically oriented anterior and posterior pelvis
 Complete Pelvic Floor + posterior SI + sacrospinous
and sacrotuberous ligaments
 Post. Sacroiliac ligaments  Vertical Stability
 Unstable Fractures!

9.  http://lifeinthefastlane.com/education/who-
was/eponymous-fractures/
 http://online-media.unimarburg.de/radiologie/kap12.htm
 http://www.wheelessonline.com/ortho/malgaigne_fra
cture_vertical_shear
 Simon, Robert, and Scott Sherman. Emergency
Orthopedics. New York: McGraw Hill, 2011. 6th Ed.