2. DEFINITION
Injuries or fractures that involve the pelvis
bone and structure
Why important?
Highest mortality in pelvic fractures
Rates can reach 20%
Amount of force causing unstable pelvic fractures
also causes severe organ damage
13. Why it bleeds so much?
Pre-sacral venous plexus
overlies the SI joint
Fracture disrupts SI joint
Tears the veins
BLEEDS!
14. Pelvis forms a limited
container
Disrupted pelvic ring
opens this container
Haemorrhage leaks into
retroperitoneum
MASSIVE BLEED
(5-6 LITRES)
15. What to do?
A&E level
Follow ATLS protocol (ABCDE)
Most important to fluid resuscitate
As massive bleeding suspected – blood
must be transfused (volume expanders
while waiting blood)
Application of temporary pelvic
stabilizer (binder / c-clamp)
18. What to do?
Orthopaedic role
To decrease pelvis volume by
stabilizing with external fixators
Why? – to contain the
haemorrhage
Bleeding will stop due to
TEMPONADE effect
19. How to do?
Pin placement:
2cm posterior to ASIS along iliac crest
Reduction:
If open book – internal rotate the hip
If vertical shear – traction through a supracondylar
pin 1st
Hold:
At least 2 bars must be clamped together
20. Pelvic # classification (Tile’s)
Type A – STABLE
A1 – # not involving ring
A2 – stable, minimally displaced ring #
21. Type B – Rotation unstable, Vertical stable
B1 – open book
B2 – lateral compression: ipsilateral
B3 – lateral compression: contralateral
B1 B2