Pelvic injury
these kill by bleeding
The pelvis cannot tamponade a bleed!
mechanisms
low energy → pelvic ring intact
| Site | Context | |
|---|---|---|
| Avulsion | ASIS, AIIS, pubis | sudden muscle contraction - athletes |
| Direct | iliac crest/ischium | low impact fall |
| Stress | pubic rami, SIJ | osteoporosis, malignancy |
high energy → disruption of pelvic ring
| Direction of force | Site | Context |
|---|---|---|
| AP | pubic symphysis separates | frontal RTC collision |
| Lateral | RTC | |
| Vertical shear | displaced ant rami + SIJ dislocation THE MOST UNSTABLE |
fall from height/axial loading |
classification: Young Burgess (useful in ED)
immediate assessment + management
- A-E is king as always
- Pelvic binder as part of C - APPLY IF IN DOUBT
- check perineum, genitals, rectum for blood
- suggests open pelvic fracture
- PR blood + penetrating injury → bowel perf?
- AVOID log roll unless suspicion of actively bleeding back wounds
- Major haemorrhage protocol
where to next?
- Theatre → damage control surgery
- IR? → embolisation
when does the pelvic binder come off?
- there is no pelvic fracture, or
- a pelvic fracture is identified as mechanically stable, or
- the binder is not controlling the mechanical stability of the fracture, or
- there is not further bleeding and coagulation is normal
- or after 24h - prevent pressure ulcers
Repeat pelvic XR after pelvic binder comes off
a well-applied binder can mask fracture
associated injuries
- Urethral injury
- get experts (urology) to catheterise if you suspect this
pathogenesis
Source of bleeding:
- pelvic venous plexus (90%)
- pelvic arteries (10%)
- surfaces of broken bones