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Pelvic fractures

Pelvic fractures. Francis Connon Royal Melbourne Hospital. Anatomy of the Pelvis. Who sustains pelvic fractures?. Case study 1. A 22 year old male is brought into the ED following a car crash on the Ring Road. He has significant bruising around his perineum and lower abdomen.

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Pelvic fractures

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  1. Pelvic fractures Francis Connon Royal Melbourne Hospital

  2. Anatomy of the Pelvis

  3. Who sustains pelvic fractures?

  4. Case study 1 • A 22 year old male is brought into the ED following a car crash on the Ring Road. He has significant bruising around his perineum and lower abdomen. • What is your initial approach?

  5. Initial Management • Airway • Breathing • Circulation • Disability • Environment/Exposure • AMPLE history (Allergies, Medications, Past history, Last Meal, Events) • Primary Investigations

  6. Initial Management • Airway – intubated, C-spine immobilised • Breathing – Pneumothorax- ICC inserted • Circulation – BP 95/50, HR 134 Is this patient in shock?

  7. Initial Management • Circulation – BP 95/50, HR 134 Is this patient in shock? Yes!! Blood loss is approximately 30-40% of total blood volume, ie. 1.5-2L • IV fluids (2L stat) through large bore cannulas in each cubitalfossa, then blood transfusion as required. • Pelvic binder • Find and stop the bleeding! -embolisation -laparotomy

  8. Initial Management • Airway • Breathing • Circulation • Disability – lower limb, sacral plexus • Environment/Exposure • AMPLE history (Allergies, Medications, Past history, Last Meal, Events) • Primary Investigations

  9. Pelvic Ring Fractures

  10. General Principles of Fracture Management Immobilisation Conservative Internal Fixation -wires -plates -intramedullary nails -screws External Fixation -traction -external fixators -cast Rehabilitation • Analgesia • Treatment of underlying pathology eg. osteoporosis • Outpatient follow-up • Physiotherapy • Occupational Therapy eg. Wheelchair • Social Work

  11. TREATMENT • Haemostasis -pressure (pelvic binder) -embolisation -laparotomy • Further Ix- CT, cystogram • Reduction • Immobilisation • Document neurovascular status pre and post-op • Associated injuries eg. Urological, Neurological, Reproductive • Rehabilitation and follow-up

  12. Classification • Many systems: Bucholz, Letournel, Young Burgess • Mechanism of injury -high/low velocity -direction A-P vs lateral forces on hip joint • Most important questions: -is the pelvis stable? -is the acetabulum intact? -open or closed?

  13. Questions?

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