Ortho - PELVIS Flashcards
(13 cards)
Is a single break in a pelvis considered generally stable or unstable?
stable
2 ring fracture = unstable
A scotal haematoma in a trauma pt is a clue to what other injury?
May have pelvic fracture =Destot’s sign
Leg length disrepancy or rotational deformity without obvious leg fracture suggest what injury?
pelvic fracture
What findings/absence of findings is the clinician looking for when doing a rectal examination of a trauma patient?
High riding prostate
rectal injury
Abnormal bony prominence (pelvic fracture)
Tenderness along suspected fracture line
Large haematoma
Anal tone and sensation
What is the reason for urgent pelvic xray in a trauma room for a new trauma pt?
For **unstable ** pts for rapid detection of
identification, stabalisation and rapid mobilisation of resources for emergency angiography
If no tenderness to palpation in stable alert pt, no need for AP pelvis xray
If susected hip fracture but stable who will go for CT anyway, no need for XRAY pelvis
What is the sensitivity of plane film of the pelvis to detect a fracture compared to CT?
< 85%
What type pattern of pelvic fracture (lateral, AP compression or veritcal sheer) will cause this cause this injury: “ at a minimum the pubic ramus is fractured. If further forces, the sacroiliac joint is crushed leading to disruption of the posterior ligaments, fracture of the sacrum and rotation of the contralateral hemipelvis
Lateral compression fracture
60 - 70% of pelvic fractures will be from lateral compression. 8% mortality
The below list of fractures are generally managed in the same way, how are they managed?
Isolated fractures of anterior superior iliac spine, anterior inferior iliac spine, ischial tuberosity, single pubic ramus, body of ischium, iliac wing, sacrum, coccyx
Stable, generally do not need surgical repair
Anaglesia
Crutches
Bed rest or non-weightbearing status
Ortho follow up at out-patient
exclude abdominal injury in iliac wing fracture and exclude neurology if sacrum fracture
How much blood can be lost into the retroperitoneal space from a pelvic fracture until self tamponade occurs?
4L
Angiography and external pelvic fixation complement each other as they each address a different type of bleeding. Which stops what bleeding?
angiography - stops arterial bleeding
Exteral pelvic fixtaion - stops venous bleeding
A pt has an isolated pevlic fracture with pelvic arterial bleeding. What are the two definitive options to stop the bleeding?
Angiography - ideally
Laparotomy for packing - next option
Some debate over when to use what. Angiography can be done in an unstable pt. If extemely unstable will need lapartomy though. If other abdo injury e.g splenic bleed, will need laparotomy
You suspect a urethral injury from a pelvic fracture. What imaging do you order before you can place an IDC?
retrograde urethrography
In addition to a DRE, what examination should you perform on a female with a pelvic fracture?
bimanual vaginal examiation and if blood found a speculum examination
assess for vaginal laceration = open fracture, given antibiotics! vaginal haematoma, urethral bleeding
