Pelvic Trauma

Assessment Be careful Inspect for deformity, wounds, echymoses Palpate the bony prominences: symphysis, iliac crests, sacrum, ischial tuberosities Gently apply lateral compression. Gently apply distraction PR if pelvic fracture demonstrated

Investigations Plain films: May not rule out injury but will exclude fracture as cause for major bleed FAST scan – if haemodynamically unstable and IR possible then may decide destination VBG, FBE, group and hold CTAP with contrast

Classification Young-Burgess system: Know it for exams Anteroposterior compression (APC) I-III Lateral compression (LC) I-III Vertical shear (VS) Combined mechanism (CM) Know it for exams Think stable, rotationally unstable or rotationally and vertically unstable.

In pictures

Associated injuries Bladder/urethra Bowel Solid abdo organs

Management Stabilise the fracture – pelvic binder, bedsheet etc Decreases pain Decrease further injury Decrease pelvic volume* Tamponade bleeding* *less than you think

Haemorrhage control IR vs packing – controversial 90% of bleeding pelvic fractures is venous – but not in patients with ongoing instability You can lose all your blood into the pelvis and retroperitoneal space Unstable patients at Hervey Bay need to go to theatre. Nowhere else!