1. Pelvic Trauma

2. 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

3. 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

4. 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.

5. In pictures

6. Associated injuries
Bladder/urethra
Bowel
Solid abdo organs

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

8. 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!