In which two age groups do pelvic fractures occur?
- Young (high energy)
- Old (osteoporosis and low energy)
In the pelvic ring is disrupted in one place then it will be what?
Also disrupted in another location
Why is there a serious risk of hypovolaemia with pelvic fractures?
The interal iliac artery and pre-sacral venous plexus are prone to injury
What are the three main patterns of pelvic injury?
- Lateral compression fracture
- Vertical shear fracture
- Anteroposterior compression injury
What is a lateral compression fracture of the pelvis and how does it occur?
Half of the pelvis is displaced medially
What is a vertical shear fracture and how does it occur?
Axial force on one hemipelvis causing superior displacement
What is at risk during a vertical shear frcature?
- Sacral nerve roots and lumbosacral plexus
- Major haemorrhage
What is a clinical sign that a vertical shear fracture has occured?
The leg on the affected side will be shorter
Why is an anteroposterior compression injury sometimes called an open book pelvic fracture?
There is wide disruption of the pubic symphysis and the pelvis opens up like the pages in a book
How can blood loss be treated in pelvic fractures which involve high blood loss?
- IV fluids
In terms of bleeding why are anteroposterior compression injuries of the pelvis arguably the most dangerous?
Pelvic space increases greatly in size so more blood can be held encouraging bleeding
How can bleeding be reduced especially in anteroposterior compression injuries of the pelvis?
- Tied sheet or pelvic binder to reduce pevic space
- External fixator
Ongoing haemodynamic instability due to a pelvic fracture requires what?
- Angiogram and embolisation
- Open packing of the pelvis
Why is a PR exam mangatory in a serious pelvic fracture?
- To assess sacral nerve root function
- Look for presence of blood
Pelvic injuries to the elderly tend to require what treatment?
(they are minimally displaced)
Posterior wall fracture of the acetabulum are generally associated with what?
How can the pattern of a posterior wall fracture of the acetabulum be determined?