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2025 Part Twos > Trauma: Pelvic > Flashcards

Trauma: Pelvic Flashcards

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1
Q

What percentage of pelvic fractures are associated with other injuries?

A

65%

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2
Q

What are the primary causes of mortality in pelvic fractures?

A

Bleeding and infection

These complications can arise from the injury itself or subsequent medical issues.

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3
Q

What are the common sources of bleeding in pelvic fractures?

A
  • Bones
  • Venous plexi
  • Arteries
  • Extrapelvic

Understanding these sources is crucial for managing hemorrhage in pelvic injuries.

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4
Q

How much blood can the pelvis accommodate?

A

> 3L

This capacity makes pelvic fractures particularly dangerous due to the potential for significant blood loss.

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5
Q

What structures are at risk due to sacroiliac joint disruptions?

A
  • Iliac vessels
  • Sacral nerve roots
  • Ureters

Disruption can lead to significant functional impairments and complications.

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6
Q

What muscle and fascia overlie the sacroiliac joint?

A

Psoas muscle and fascia

Swelling in this area can lead to compartment syndrome.

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7
Q

What can swelling inside the fascia overlying the SI joint lead to?

A

Compartment syndrome and compression of the femoral nerve

These conditions can exacerbate the injury and lead to further complications.

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8
Q

What is the primary question in the Tile Classification of pelvic fractures?

A

Is the pelvic ring disrupted?

This classification helps determine the stability of the injury.

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9
Q

What are the two types of forces acting on the pelvis in pelvic fractures?

A
  • Lateral
  • Anterior-Posterior (AP) compression

The direction of the force influences the type of injury sustained.

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10
Q

What are the two types of pelvic destabilization according to the Tile Classification?

A
  • Rotational (open book)
  • Lateral shear

Identifying the type of destabilization helps guide treatment decisions.

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11
Q
A
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12
Q

What characterizes a Type A pelvic fracture?

A

Stable fracture that does not disrupt pelvic ring (iliac wing #, transverse sacral #, pubic rami #)

Also known as posterior elements fractures.

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13
Q

What is the difference between Type B and Type C pelvic fractures?

A

Type B is rotationally unstable, vertically stable; Type C is rotationally and vertically unstable

Type B fractures have incomplete disruption of posterior structures, while Type C fractures have complete disruption.

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14
Q

What is an open book injury in Type B fractures?

A

Disruption of symphysis with posterior disruption of SI joint, possibly accompanied by fracture of pubic rami

This is classified as B1.

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15
Q

What are the associated risks with Type B and C pelvic fractures?

A

High risk of associated abdominal injury

Pelvic fractures extending into the sciatic notch are also associated with bleeding due to disruption of gluteal vessels.

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16
Q

What should be assessed during a clinical examination for pelvic fractures?

A

Tenderness, instability, perineum/groin for laceration, vagina/rectum for injury

Specific signs include a high riding prostate indicating urethral avulsion.

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17
Q

What does leg length discrepancy or rotational deformity without appropriate lower limb fracture indicate?

A

Possible unstable pelvis

An unstable pelvis migrates cephalad due to muscular pull and rotates outwards due to gravity.

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18
Q

What percentage of bleeding from pelvic fractures is venous?

A

85%

This bleeding is from venous plexuses around the pelvis and is not controllable by embolization.

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19
Q

What investigation should be performed if a patient is unstable?

A

FAST (Focused Assessment with Sonography for Trauma)

This helps determine whether blood loss is abdominal or pelvic.

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20
Q

What investigation is appropriate for stable patients with pelvic fractures?

A

CT angiogram +/- embolisation

If the patient is responding, a CTA may be done if time allows.

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21
Q

What should be done if there is evidence of perineal injury or haematuria?

A

Investigate with retrograde urethrogram followed by cystogram or CT cystogram (NON URGENT)

This helps assess for injuries in the urinary tract.

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22
Q

What happens in the case of retroperitoneal hematomas?

A

They may break into the peritoneal cavity

.

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23
Q

What is the initial management step for pelvic trauma?

A

Bind the feet to reduce distraction of bones

This step helps stabilize the pelvic area.

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24
Q

What is used for external compression in pelvic trauma management?

A

Pelvic binder

This device helps control bleeding and stabilize the pelvis.

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25
What should be assessed in a patient with pelvic trauma?
Haemodynamic stability ## Footnote This assessment determines the urgency of further interventions.
26
What is the management approach for a stable pelvic trauma patient?
External fixation and future ORIF ## Footnote Operative fixation should be performed as soon as possible.
27
What may be required for stable pelvic trauma patients?
Faecal diversion
28
What is the next step if the patient is unstable?
Perform a FAST scan ## Footnote FAST stands for Focused Assessment with Sonography for Trauma.
29
What does a grossly positive FAST scan indicate?
Laparotomy and possible pelvic packing ## Footnote Pelvic packing is done to control bleeding around the external iliac vessels.
30
What is the procedure for grossly negative FAST scan results?
Angiography and embolization of arterial bleeders ## Footnote If the patient is too unstable, immediate packing may be performed instead.
31
What is the incision type for pelvic packing?
5cm suprapubic incision ## Footnote Remember not to make incision continous with laparotomy, otherwise bleeding will not tamponade, but continue into the abdomen
32
What is the first step in the packing procedure?
Divide the anterior fascia until the pubic symphysis is palpated ## Footnote This step helps gain access to the extra-peritoneal space.
33
What should be followed to reach the pelvic floor during packing?
Pelvic brim to SI joint ## Footnote Blunt dissection is often facilitated by existing hematomas.
34
How should the packing be performed?
Start posteriorly and work anteriorly with abdominal swabs ## Footnote This method ensures effective tamponade of bleeding.
35
What should be avoided when making the incision for pelvic packing?
Continuous incision with laparotomy ## Footnote This prevents bleeding from continuing into the abdomen.
36
What percentage of trauma patients experience renal trauma?
10% ## Footnote This statistic indicates the prevalence of renal injury among trauma patients.
37
What type of trauma is the majority associated with renal injury?
Blunt trauma ## Footnote Blunt trauma accounts for the most cases of renal injury.
38
What percentage of penetrating renal trauma involves multiorgan involvement?
80% ## Footnote This highlights the complexity and severity of penetrating injuries.
39
What percentage of blunt renal trauma cases involve multiorgan involvement?
75% ## Footnote This indicates that blunt trauma can also lead to injuries of multiple organs.
40
What is the hallmark sign of renal trauma?
Haematuria ## Footnote Haematuria is present in 95% of renal trauma cases.
41
True or False: The absence of haematuria rules out serious renal trauma.
False ## Footnote Serious renal trauma can still occur even if haematuria is absent.
42
43
What is a grade one renal trauma? - contusion - haematoma
Microscopic or gross haematuria, urological studies normal Subcapsular, non-expanding without parenchymal laceration
44
What is a grade two renal trauma? - haematoma - laceration
Non-expanding perirenal, confined to renal retroperitoneum <1cm parenchymal depth without urinary extravasation
45
What is a grade three renal trauma? - Laceration
>1cm parenchymal depth without collecting system rupture or urinary extravasation
46
What is a grade four renal trauma? - Laceration - vascular injury
Parenchymal laceration extending through renal cortex, medulla, collecting system Main renal artery or vein with contained haemorrhage
47
What is a grade 5 renal trauma? - laceration - vascular
Completely shattered kidney Avulsion of renal hilum
48
What should be assessed at laparotomy for an unstable patient?
Whether kidneys are the source of shock ## Footnote This assessment is crucial in determining the management of the patient's condition.
49
What can be done in a damage control situation around the kidney?
Pack around kidney and consider angio or IV urogram ## Footnote This approach helps stabilize the patient before definitive management.
50
How can many renal injuries in stable patients be managed?
Non-operatively ## Footnote This is particularly true for lower-grade injuries.
51
What is the recommended management for Grade I/II renal injuries?
Non-operative management +/- angio-embolisation ## Footnote Angio-embolisation can help control bleeding in some cases.
52
What is a possible surgical intervention for Grade III renal injuries?
Sutured lacerations to renal pelvis with omental patch and drains left ## Footnote This method allows for healing while managing complications.
53
What is often required for Grade IV renal injuries?
Surgery and may need nephrectomy ## Footnote Nephrectomy may be necessary depending on the extent of the injury.
54
What is usually required for Grade V renal injuries?
Nephrectomy ## Footnote Grade V injuries are typically the most severe, necessitating removal of the kidney.
55
What percentage of patients with pelvic fracture have significant bladder injury?
≈10% ## Footnote This statistic highlights the relationship between pelvic fractures and bladder trauma.
56
What type of bladder injury is usually associated with pelvic fractures?
Extraperitoneal (pelvic uroma) ## Footnote Typically occurs due to pelvic fractures.
57
What are combination injuries of the bladder usually a result of?
Penetrating injury ## Footnote These injuries involve both intraperitoneal and extraperitoneal components.
58
What type of trauma accounts for 75% of bladder injuries?
Blunt trauma ## Footnote Often involves direct blows to a full bladder, such as from a seatbelt or steering wheel.
59
What are the three types of bladder rupture classifications?
Anterior, Posterior, Superior ## Footnote Anterior involves the space of Retzius, posterior involves the retrovesical space, and superior involves the peritoneal cavity.
60
What are common clinical presentations of bladder trauma?
Haematuria, suprapubic pain or tenderness, difficulty or inability to void ## Footnote Symptoms may vary based on the type of rupture.
61
What may occur with intraperitoneal extravasation?
Peritoneal signs, hyperkalaemia, hypernatremia, uraemia, acidosis ## Footnote These complications may develop due to fluid absorption.
62
What is the most common form of injury after blunt trauma to the bladder?
Contusion (partial-thickness) injury ## Footnote This type of injury is prevalent in cases of blunt trauma.
63
What increases the probability of bladder injury?
Increased fullness of the bladder ## Footnote A fuller bladder is more susceptible to injury from blunt force.
64
What is the characteristic feature of intraperitoneal ruptures?
Large horizontal tears in the dome of the bladder ## Footnote These types of ruptures are more common in children.
65
What investigation is used to exclude urethral injury?
Cystogram retrograde cystography ## Footnote This imaging technique assesses the urethra and bladder.
66
What is the minimum volume of contrast required for a cystogram?
7mL/kg urograffin (minimum 350ml of DILUTE contrast) ## Footnote Adequate contrast volume is crucial for clear imaging.
67
When should a CT scan be performed in cases of suspected bladder injury?
If shocked + haematuria ## Footnote Particularly critical in children with haematuria.
68
How are most extraperitoneal injuries managed?
Non-operatively with IDC insertion for 2 weeks then contrast cystogram ## Footnote This approach allows for conservative management of these injuries.
69
How are intraperitoneal injuries repaired?
From within the bladder with absorbable sutures ## Footnote Repair techniques focus on minimizing further complications.
70
What should be done with the IDC after repair of an intraperitoneal injury?
Leave IDC in situ for 2 weeks ## Footnote This allows for proper healing and monitoring.
71
How may bladder injuries be classified?
intraperitoneal: ‘extravasation’ of urine – associated with impact to a full bladder - "pop goes the bladder" extraperitoneal: (pelvic uroma) – usually associated with pelvic # Combination injuries: – usually from penetrating injury
72
How may urethral injuries be classified?
posterior and anterior ## Footnote Posterior includes prostatic and membranous urethra; anterior includes bulbar and penile urethra.
73
What types of injuries are associated with posterior urethral injury?
Pelvic fractures and deceleration injuries ## Footnote N/A
74
What types of injuries are associated with anterior urethral injury?
Iatrogenic or straddle injuries ## Footnote May present years later with stricture.
75
What are common clinical signs of urethral injury?
* Pain * Swelling / ecchymosis * Blood at urethral meatus * Haematuria * Inability to void * Rectal findings (boggy mass, mobile prostate, high riding prostate) ## Footnote High riding prostate indicates complete urethral avulsion.
76
What is the pathology associated with anterior urethral injury?
Extravasation within Colles fascia ## Footnote N/A
77
What is the initial investigation for urethral injury?
Retrograde urethrogram ## Footnote N/A
78
What is the initial management for suspected urethral injury?
* IDC (Indwelling Catheter) * SPC (Suprapubic Catheter) * Antibiotics ## Footnote IDC placement is controversial if there is a high suspicion of injury.
79
What should be done if the prostate is normal during an examination?
A single gentle attempt to pass a catheter can be made ## Footnote This may be enough to treat a partial injury.
80
What is a disadvantage of suprapubic catheterization?
Increased risk of contamination for subsequent orthopedic repairs of pelvic fractures ## Footnote N/A
81
What are the indications for surgical primary repair of urethral injury?
* Penetrating injury * Posterior injury with associated rectal or bladder neck injury * Ends of urethra widely separated * Penile fracture ## Footnote N/A
82
What is the technique for surgical primary repair of urethral injury?
Perineal incision, drainage, and primary repair ## Footnote Remaining repairs can be delayed for 6 months.
83
What are late sequelae of urethral injury?
* Stricture * Impotence * Incontinence ## Footnote N/A
84
True or False: Blood at the meatus alerts to the presence of urethral injury.
True ## Footnote N/A
85
What should be assessed prior to placement of an IDC in the context of pelvic trauma?
Examine for a high riding prostate ## Footnote N/A
86
What is the preferred management for urethral injury?
SPC insertion ## Footnote Avoid the extraperitoneal approach as extraperitoneal hematoma may be disrupted.

2025 Part Twos (48 decks)

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