Pelvic Fractures

Question 1

In which two age groups do pelvic fractures occur?

Answer 1

1. Young (high energy)
2. Old (osteoporosis and low energy)

Question 2

In the pelvic ring is disrupted in one place then it will be what?

Answer 2

Also disrupted in another location

Question 3

Why is there a serious risk of hypovolaemia with pelvic fractures?

Answer 3

The interal iliac artery and pre-sacral venous plexus are prone to injury

Question 4

What are the three main patterns of pelvic injury?

Answer 4

1. Lateral compression fracture
2. Vertical shear fracture
3. Anteroposterior compression injury

Question 5

What is a lateral compression fracture of the pelvis and how does it occur?

Answer 5

Half of the pelvis is displaced medially

Side impact

Question 6

What is a vertical shear fracture and how does it occur?

Answer 6

Axial force on one hemipelvis causing superior displacement

Question 7

What is at risk during a vertical shear frcature?

Answer 7

1. Sacral nerve roots and lumbosacral plexus
2. Major haemorrhage

Question 8

What is a clinical sign that a vertical shear fracture has occured?

Answer 8

The leg on the affected side will be shorter

Question 9

Why is an anteroposterior compression injury sometimes called an open book pelvic fracture?

Answer 9

There is wide disruption of the pubic symphysis and the pelvis opens up like the pages in a book

Question 10

How can blood loss be treated in pelvic fractures which involve high blood loss?

Answer 10

1. IV fluids
2. Blood

Question 11

In terms of bleeding why are anteroposterior compression injuries of the pelvis arguably the most dangerous?

Answer 11

Pelvic space increases greatly in size so more blood can be held encouraging bleeding

Question 12

How can bleeding be reduced especially in anteroposterior compression injuries of the pelvis?

Answer 12

1. Tied sheet or pelvic binder to reduce pevic space
2. External fixator

Question 13

Ongoing haemodynamic instability due to a pelvic fracture requires what?

Answer 13

1. Angiogram and embolisation
2. Open packing of the pelvis

Question 14

Why is a PR exam mangatory in a serious pelvic fracture?

Answer 14

1. To assess sacral nerve root function
2. Look for presence of blood

Question 15

Pelvic injuries to the elderly tend to require what treatment?

Answer 15

Conservative management

(they are minimally displaced)

Question 16

Posterior wall fracture of the acetabulum are generally associated with what?

Answer 16

Hip dislocations

Question 17

How can the pattern of a posterior wall fracture of the acetabulum be determined?

Answer 17

1. Plain X-rays (with oblique views)
2. CT scans