Francis Connon Royal Melbourne Hospital Pelvic fractures Francis Connon Royal Melbourne Hospital

Anatomy of the Pelvis

Who sustains pelvic fractures? Young people High-velocity eg. MVA, MBA Old people Low velocity eg. falls Osteoporosis

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?

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

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

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 cubital fossa, then blood transfusion as required. Pelvic binder Find and stop the bleeding! -embolisation -laparotomy

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

Pelvic Ring Fractures

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

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

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?

Questions?