Injury Fracture Vascular injury Compartment syndrome Open wound Crush injury Nerves Patient Previous Condition Age (physiologic) Diagnoses Medications! Other injuries Physiologic response Expectations/needs Care Team Surgeon Assistants Anesthesia Other specialties OR nurses Postoperative Rehabilitation Social supports Resources OR Instruments Implants Imaging ICU (Other Patients)
Pelvic immobilisation should be routine MOI Symptoms Clinical findings – deformity, bruising or swelling over the bony prominences, pubis, perineum or scrotum. – Leg length discrepancy or rotational deformity of a lower limb (without fracture in that extremity) may be evident. – Wounds over the pelvis or bleeding from the patient's rectum, vagina or urethra may indicate an open pelvic fracture. – Neurological abnormalities may also rarely be present in the lower limbs after a pelvic fracture.
Ease of application Access for intervention Shown just as good as external fixators
Prehospital ED ITU & anaesthetics Ortho Gen Surg HBP CT/radiology Interventional radiology Urology Rehab Pain team Sexual dysfunction clinic Clinical psychology Holistic Approach Improve disability
How much blood loss from pelvic #? WBV – (true pelvic vol 1.5L, but ↑ with disruption) – Retroperitoneal space 5L – Loose tamponade effect/disruption parapelvic fascia – Escape into peritoneum & thighs
? Arterial Bleeding MOI Open fractures Elderly patients (gluteal injuries) Sacrum/SIJ, symphyseal separation–gluteal, pudendal CT scan – vascular blush/large haematoma≡sig bleed AttachmentSize Head on collisions Jumpers
Binder MHP Trauma CT Urology Surgery Pelvic fixation Holistic Rehab Coordinated Team Approach
Isolated haemodynamically unstable pelvic trauma uncommon – Associated injuries due to high MOI Resuscitation/intervention team based with better understanding & cooperative team working – surgeons included