PELVIC

FRACTURE

 Incidency

0,3-6% of all fracture

Occur in 20% of all polytrauma cases
cause of Fracture:
- traffic accident
- fall from high place
- minor trauma
- atlet
Mortality rate: 10-50%
Complication to the other organ

Anatomy
The pelvis is the region of the body surrounded by the
pelvic bones and the inferior elements of the vertebral column.

The bones of pelvis consist of :

1.The right and le7 pelvic bones
2.The sacrum
3.The coccyx

The stabilizing structures of the pelvic ring:

symphysis pubis,
the posterior sacroiliac complex,
the pelvic floor

High-energy fractures:
motor vehicle, 57%; pedestrian, 18%;
motorcycle, 9%; falls from heights, 9%; and
crush, 4%
often result in two or more fractures of the
pelvic ring
AP force, lateral impacts, vertical shear
Penetrating mechanisms: associated visceral
and neurovascular injuries

Low-energy fractures isolated fractures

do not damage the true integrity of the ring
structure
domestic falls: "straddle" injury from a fall in
the bathtub elderly population
avulsion injuries of the muscle apophyses in
skeletally immature patients.

 Ideally

:
- Morbidity and mortality
- Treatment
- prognose

Type A : Stable
A1.Fx of the pelvic not involve the ring
A2.Minimally displace fx of the ring

Type B : Rotationally unstable, vertically stable

B1,open book
B2.Lateral comp,ipsilateral
B3.Lateral comp,contra lateral

Type C : Rotationally and vertically unstable

C1.Unilateral
C2.Bilateral
C3.Ass with acetabular Fx

 History

Fractures due to high-energy trauma

motor-vehicle accidents,
falls from height,
crushing injuries;

Fractures due to low-energy trauma

simple falls at home

Physical

exam
Primary Survey :

The general physical examination ATLS guide

according to American College of Surgeons on
polytrauma

Secondary survey
Any

deformity of pelvic and inferior extremity

Grey tuner sign: bruises at the flank area that
indicate the retroperitoneal bleeding
Leg

length discrepancy > 1 cm suspect #

pelvic

-Tenderness or instability
-Earle's sign : Palpating the swelling or
hematoma on the pelvic
-Maneuver pelvic springing
Gentle Compression/distraction on SIAS
-Femoral artery pulsation + distal part
-Sensory and motoric test suspect sciatic
nerve injury
-Rectal examination suspect urethra injury

 Injuries

CNS, Chest, Abdomen

Hemorrhage
Open pelvic facture
Urogenital system

 DPL
CT

Scan
Focused Abdominal Sonogram for trauma
Experienced hands
DPL or CT

 The

completely unstable
type C pelvic fracture:

Translates abnormally
both vertically and
posteriorly with no firm
end point when a pushpull force is applied to the
limb.

Prevent repeated
manipulation displace
clot, greater blood loss,
neurologic injury !!!!

Plain Radiography
AP
Inlet

This view shows posterior displacement

of the sacroiliac complex

Outlet

entire sacrum, including both

sacroiliac joints, and will also show
superior migration of the iliac crest.

Further define the posterior

pelvic injury
Possible associated acetabular
fracture
CT is not emergency evaluation

Within
30 minutes

 Goals:

1.
2.
3.
4.

Stability hemodinamic
Return bony anatomy
prevent deformity
functional

 Bed

rest
pelvic sling
Traction
PASG ( Pneumatic Anti Shock Garment )

 External

fixation
Internal fixation
Percutaneus fixation

1. Pelvic Clamp

2. Pin External Fixator

3. Skeletal traction

skeletal-traction pin in the distal femur is

recommended as a temporary measure

 Uncontrolled

Hemorrhage
Complications of External or internal Fixation
Infection
Neurologic Complications
Thromboembolism
Persistent Pelvic Pain
Malunion
Nonunion
Urologic and Gynecologic Problems

THANK
YOU