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PELVIC RING FRACTURES
Pelvic fractures occur as a result of high-energy trauma and
are frequently accompanied by injuries to the genitourinary
system and abdominal organs. Internal blood loss caused by
fracture of the pelvis and soft organ damage causes hypovolaemic
shock (see page 13–8).
Stable fractures are those with a single fracture component
(Figure 18.42). Unstable patterns result from fractures at
two or more sites, or those associated with disruption of the
symphysis pubis or sacroiliac articulation (Figure
18.43).
Evaluation
Physical examination findings include:
| :: |
Flank
ecchymosis |
| :: |
Labial
or scrotal swelling |
| :: |
Abnormal
position of the lower extremities |
| :: |
Pain
with pelvic rim compression. |
If
the fracture is unstable, you will feel differential motion
of the pelvic components when gently manipulating them. Place
your hands on the iliac wings and gently rock the pelvis. Confirm
the diagnosis with an anterior-posterior X-ray of the pelvis.
Additional inlet and outlet views help determine the extent
of the fractures.
Remember to focus on a systematic examination of the whole
patient (see page 16–2).
Treatment
| :: |
Focus
the initial management on general resuscitation efforts
(see page 13–1 to 13–9). |
| :: |
Focus
the initial management on general resuscitation efforts
(see page 13–1 to 13–9). |
| :: |
Focus
the initial management on general resuscitation efforts
(see page 13–1 to 13–9). |
| :: |
Manage
stable pelvic fractures with bed rest and analgesics.
Stable fractures are rarely associated with significant
blood loss. |
Unstable fractures
Unstable fractures are associated with visceral damage and
there is often significant bleeding. As an emergency procedure:
| 1 |
Place
compression on the iliac wings, using a sheet or sling
to close the pelvic space and tamponade active bleeding
(Figure 18.44). |
|
| 2 |
Treat
with a pelvic sling and/or traction on the leg to reduce
the vertical shear component of the fracture (Figure
18.45). |
|
| 3 |
Maintain
the traction until the fracture has consolidated. This
usually takes 8–12 weeks. |
|
|
| |
 |
|
 |
Pelvic
ring fractures result from high-energy trauma and are
classified as stable or unstable
|
 |
|
Unstable
fractures are associated with significant blood loss
and multiple system injury
|
|
|
Treat
initially with systemic resuscitation and temporary
pelvic compression
|
|
|
Complications
include deep vein thrombosis, sciatic nerve injury
and death from bleeding or internal organ damage.
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