1. Francis Connon Royal Melbourne Hospital
Pelvic fractures
Francis Connon
Royal Melbourne Hospital

2. Anatomy of the Pelvis

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

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

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

8. 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 L
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

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

10. Pelvic Ring Fractures

11. 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

12. 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

13. 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?

14. Questions?