Pelvic Fracture Flashcards

1
Q

What is the pelvic ring?

A

Formed by two innominate bones (i.e. ilium, ischium and pubis) + the sacrum and supporting ligaments.

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2
Q

What does the true pelvis contain?

A

Female = Rectum, bladder and uterus + iliac vessels and lumbosacral nerve roots

Male = Rectum, bladder

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3
Q

Associated injuries of pelvic fractuers

A

Life-threatening haemorrhage

Neurological deficit

Urogenital trauma

Bowel injury

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4
Q

Mechanism of injury

A

Caused by both high and low energy trauma

Most common is high energy blunt trauma from RTAs or falls from height.

The damage occur either at bony or ligamentous points

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5
Q

Clinical features

A

Obvious deformity

Significant pain and swelling

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6
Q

Examination

A

Full neurovascular assessment

Check anal tone, sacral nerve roots and iliac vessels.

Also check for abdo injuries, urethral injuries and open fractures

Open fractures can also be internal meaning they go into rectum or vagina

Also check for ecchymosis and developing haematoma

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7
Q

Dx

A

Head, chest, spine and other bone fracture

Concurrent acetabular fractures can happen as well

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8
Q

What are low energy pelvic fractures?

A

Typically avulsion fractures if in young.

Sudden severe pain that is poorly localised to hip and pelvis.

The pain is felt while performing a rapid, powerful movement like starting to run.

Site most commonly affected are ASIS (sartorius), AIIS (rectus femoris) and ischial tuberosity (hamstring muscles).

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9
Q

How are low energy pelvic avulsion fractures treated?

A

Conservatively unless significantly displaced

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10
Q

Ix

A

Any patient with high-energy injury with suspected pelvic fracture must be assessed and managed as per ATLS guidelines.

Minimum of 3 plain film radiographs to assess the pelvic ring (AP, inlet view and outlet view)

CT scan is commonly performed in trauma setting instead.

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11
Q

Classification systems for pelvic ring injuries

A

Young and Burgess

Tile

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12
Q

Explain Young and Burgess classification

A

Based on the evctor of the disrupting force and the resulting degree of displacement

AP compression (1-3)

Lateral compression (1-3)

Vertical shear (1-2)
Complete loss of attachment between sacrum and lower limb (uni (1), bilat (2))
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13
Q

Explain Tile classification

A

Based on stability of the pelvic ring

A-type = Rotationally and vertically stable

B-type = Horizontally unstable but vertically stable

C = Both horizontally and vertically unstable

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14
Q

What is the Denis classification?

A

To classify fractures of the sacrum

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15
Q

General management

A

Any patient with high energy trauma and suspected pelvic ring fracture should be managed by ATLS with resuscitation and stabilisation.

You should also get IV access and get bloods, clotting and Group and Save.

This is because pelvic injuries often follow with blood loss leading to hypovolaemic shock.

Any hypotensive patient with history of pelvic trauma should be assumed to have a pelvic fracture until proven otherwise.
A pelvic binder should be applied to give skeletal stabilisation

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16
Q

Types of management

A

Definitive can be either conservative or surgical

17
Q

What does the need for immediate surgical intervention depend on?

A

Response to initial resuscitation.

Haemodynicamically unstable patient might need interventional radiology or trauma laparotomy +/- retriperitoneal packing.

18
Q

Indications for surgical intervention

A

Life-threatening haemorrhage

Unstable fracture

Open fractures

Concurrent urological injury

19
Q

What is approach + method of stabiilsation guided by?

A

Young and Burgess classification.

20
Q

What fractures can be treated conservatively?

A

APC1 and LC1 which are stable

21
Q

Surgical intervention

A

Combo of anterior and posterior stabilisation approach

22
Q

Complications

A

Urological injury (M>F)

VTE (DVT 60% vs PE 25%) - needs to be given LMWH/DOAC

Long-standing pelvic pain

23
Q

Full Young & Burgess classification

A