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Pelvic Fractures and Associated Injuries PowerPoint Presentation
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Pelvic Fractures and Associated Injuries

Pelvic Fractures and Associated Injuries

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Pelvic Fractures and Associated Injuries

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  1. Pelvic Fractures and Associated Injuries Dr Huw Williams MB BCh MCEM

  2. Pelvic Injuries in Trauma • 1o Survey A • B • C • D • E • 2o Survey • 3o Survey

  3. Pelvic Injuries in Trauma • 1o Survey A • B • C • D • E • 2o Survey • 3o Survey

  4. Pelvic Anatomy

  5. Pelvic Anatomy Sacrum Innominate bones Ligamentous complex

  6. Pelvic Fractures in Trauma • Pelvic # in approx. 9% of all major traumas • All age mortality rate = 5-to-16% • Age > 65 years mortality rate = 20% • Some mortality quotes up to 45% ?

  7. Pelvic Fractures in Trauma • Pelvic # in approx. 9% of all major traumas • All age mortality rate = 5-to-16% • Age > 65 years mortality rate = 20% • Some mortality quotes up to 45% ? • What does this mean? • ? isolated pelvic injury (without an abdominal injury) • Pelvic #s = increased risk of death

  8. Where can we bleed from?

  9. Where can we bleed from? • Pelvic venous plexus • Pelvic arterial injury • Fracture bone surfaces • Any visceral injury • Remember: extra-pelvic injuries

  10. Where can we bleed from? • Pelvic venous plexus • Pelvic arterial injury • Fracture bone surfaces • Any visceral injury • Remember: extra-pelvic injuries

  11. How much blood can we lose into our pelvis ? 1 litre ? 2 litres ? 3 litres ? 4 litres ? 5 litres ?

  12. How much blood can we lose into our pelvis ? ‘Haemorrhage from pelvic fracture is essentially bleeding into a free space, potentially capable of accommodating the patient’s entire blood volume without gaining sufficient pressure-dependent tamponade’ (Suzuki et al., 2008)

  13. Mechanism of Injury and Classification • Three mechanisms  • AP Compression Injury • Lateral Compression Injury • A Shear Force Injury  

  14. Mechanism of Injury and Classification • Three mechanisms four patterns • AP Compression Injury • Lateral Compression Injury • A Shear Force Injury • A Combination

  15. i.AP Compression Injury • How: • RTC (car vs. peadestrian / motor-cycle crash) • direct crush injury • fall (>12ft)

  16. i.AP Compression Injury • How: • RTC (car vs. peadestrian / motor-cycle crash) • direct crush injury • fall (>12ft) • What Happens: • symphysis pubis brakes  • tearing of posterior ligamentous complex • (may rupture venous plexus / internal iliac artery) AP Compression (‘open book pelvis’) Frequency = 15 to 20 %

  17. ii.Lateral Compression Injury • How: • RTC (motor-cycle crash) • Direct compression / crush

  18. ii.Lateral Compression Injury • How: • RTC (motor-cycle crash) • Direct compression / crush • What Happens: • internal rotation of hemi-pelvis  • fractures around pubis  • genitourinary system injury • (life threatening haemorrhage is less common) Lateral Compression (‘closed pelvis’) Frequency = 60 to 70 %

  19. iii.Shear Force Injury • How: • falling from a height onto one limb • RTC

  20. iii.Shear Force Injury • How: • falling from a height onto one limb • RTC • What Happens: • high-energy applied in a vertical plane  • major instability of pelvis Vertical Shear Frequency = 5 to 15%

  21. iv.Combination Tile Classification Young Classification Ross Classification

  22. iv.Combination • AP Compression Injury  • ? major haemorrhage of the venous plexus / internal iliac artery • Lateral Compression  • injury to bladder/urethra/other / ↓ pelvic volume therefore ? ↓ haemorrhage • A Shear Force  • high-energy / major instability

  23. Assessing the Pelvis ‘Springing the Pelvis’

  24. Assessing the Pelvis ‘Springing the Pelvis’

  25. Assessing the Pelvis Direct Peritoneal Lavage

  26. Assessing the Pelvis Direct Peritoneal Lavage

  27. Assessing the Pelvis PR for ? high-riding prostate

  28. Assessing the Pelvis PR for ? high-riding prostate

  29. Assessing the Pelvis Signs • Inspect flanks, scrotum, peri-anal area • ?blood at meatus / ?swelling / ?bruising / ?deep laceration • Major disruption • Leg length discrepancy • Distending Abdomen

  30. Assessing the Pelvis Symptoms • Tachycardia • Hypotension • Abdominal Pain • Pelvic Pain

  31. Assessing the Pelvis Imaging • Plain film PXRBONE • eFASTBLOOD • CT BONE / BLOOD • Angiography / CT angiography BLOOD

  32. PELVIC X-RAY PLAIN FILM • AP Compression Injury • Lat. Compression Injury • A Shear Force Injury   • A Combination • Normal

  33. PELVIC X-RAY PLAIN FILM • AP Compression Injury • Lat. Compression Injury • A Shear Force Injury   • A Combination • Normal

  34. PELVIC X-RAY PLAIN FILM • AP Compression Injury • Lat. Compression Injury • A Shear Force Injury   • A Combination • Normal

  35. PELVIC X-RAY PLAIN FILM • AP Compression Injury • Lat. Compression Injury • A Shear Force Injury • A Combination • Normal

  36. PELVIC X-RAY PLAIN FILM • AP Compression Injury • Lat. Compression Injury • A Shear Force Injury   • A Combination • Normal

  37. PELVIC X-RAY PLAIN FILM • AP Compression Injury • Lat. Compression Injury • A Shear Force Injury   • A Combination • Normal

  38. PELVIC X-RAY PLAIN FILM • AP Compression Injury • Lat. Compression Injury • A Shear Force Injury   • A Combination • Normal

  39. PELVIC X-RAY PLAIN FILM • AP Compression Injury • Lat. Compression Injury • A Shear Force Injury   • A Combination • Normal

  40. PELVIC X-RAY PLAIN FILM • AP Compression Injury • Lat. Compression Injury • A Shear Force Injury   • A Combination • Normal

  41. PELVIC X-RAY PLAIN FILM • AP Compression Injury • Lat. Compression Injury • A Shear Force Injury   • A Combination • Normal

  42. PELVIC X-RAY PLAIN FILM • AP Compression Injury • Lat. Compression Injury • A Shear Force Injury   • A Combination • Normal

  43. PELVIC X-RAY PLAIN FILM • AP Compression Injury • Lat. Compression Injury • A Shear Force Injury   • A Combination • Normal

  44. FOCUSED ABDOMINAL SONOGRAPHY IN TRAUMA -VE FAST

  45. FOCUSED ABDOMINAL SONOGRAPHY IN TRAUMA +VE FAST

  46. CT Plain film CT Scan CT 3D reconstruction

  47. CT Plain film CT Scan CT 3D reconstruction

  48. CT

  49. Angiography / • CT Angiography