Pelvic fractures: Difference between revisions
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Revision as of 00:32, 1 May 2012
Background
- Associated with:
- Hemorrhage requiring transfusion (esp w/ SI joint disruption) - 35%
- Intraabdominal injury - 16%
- Bladder/urethra injury - 6%
- Nerve deficits - 15%
- Especially with post ring fx, upper sacral fracture
- Thoracic aorta rupture - 1.5%
- If pelvic ring is disrupted there are usually two fractures
- Exception is in elderly (isolated pubic ramus) and athletes (isolated avulsion)
- Extension of fracture into the rectum or vagina = open fx
Pelvic Ring Disruptions
- Lateral Compression
- Most common
- Usually stable as affected hemipelvis is crushed inward, reducing pelvic volume
- Anteroposterior Compression
- Usually unstable as the iliac wings are forced outward, increasing pelvic volume
- Often assocciated with pelvic and retroperitoneal hemorrhage
- Coincident injuries of the thorax and the abdomen are the rule
- Vertical Shear
- Result from vertically oriented force delivered to the pelvis via the extended femurs
- Unstable; pelvic volume is increased
Imaging
- Plain films
- AP - Obtain in all unconscious blunt trauma patients
- Inlet - Better defines the pelvic brim
- Outlet - Better defines the sacrum and SI joints
- Judet - Better defines the acetabulum
- CT
- Obtain in all hemodynamically stable blunt trauma pts with pelvic fx on x-ray
- Exceptions include isolated pubic rami fx, avulsion fx
- Obtain in all hemodynamically stable blunt trauma pts with pelvic fx on x-ray
- Retrograde cystourethrogram
- Obtain (before foley) if blood at meatus, high riding prostate, or gross hematuria
- US
- May confuse hemoperitoneum for uroperitoneum
Management
- Anticipate hypotension
- Rapidly detect hemoperitoneum
- Classify fx pattern as "stable" or "unstable"
- If unstable:
- Wrap with sheet or pelvic binder
- Do not over-reduce a lateral compression fx (places increased strain on post pelvis)
- Contact IR for possible pelvic angiographic embolization
- Wrap with sheet or pelvic binder
- If unstable:
- Open Fx suggested by vaginal bleeding or rectal bleeding (uncommon)
Other Pelvic Fractures
- Straddle Injury
- Unstable
- Both rami fractured on both sides or both rami on one side w/ pubic symphysis diastasis
- High rate of urinary tract and bowel injury
- Acetabular Fractures
- Early ortho consultation and hospital admission is indicated for all
- Pelvic Avulsion Fracture
- Anterior superior iliac spine
- Occurs from forceful sartorius muscle contraction (adolescent sprinters)
- Bed rest for 3-4 wk w/ hip flexed and abducted, crutches, ortho f/u in 1-2wk
- Anterior inferior iliac spine
- Occurs from forceful rectus femoris muscle contraction (adolescent soccer players)
- Bed rest for 3-4 wk w/ hip flexed, crutches, ortho f/u in 1-2wk
- Anterior superior iliac spine
See Also
Reference
- UpToDate
- Harwood-Nuss
- Tintinalli