Open book pelvic fracture

Background

Open book fracture of the pelvis is a pelvic fracture that results from an anteroposterior compression injury to the pelvis. Often seen in elderly falls vs MVA or other high speed trauma. This causes disruption of pubic symphysis and the pelvis opens like a book, This injury results in tears of the strong pelvic ligaments that hold the pelvis bones together. Large arteries pass near these ligaments and can get torn resulting in massive blood loss.

Clinical Features

• pelvic/Hip pain
• Unstable pelvis
• hypotension if large amounts of bleed
• Consider concomitant GU injury

Diagnosis

• Unstable pelvis on exam
• Xr pelvis in acute trauma setting
• CT Pelvis

Treatment

• In acute setting, stabilize fracture with pelvic binder or bed sheet wrapped around greater trochanter (physician's often make mistake of wrapping around the iliac crest(

• If suspect pelvic injury and patient is unstable, place pelvic binder immediately then obtain X-ray when patient is stable. If no pelvic binder is available can use bed sheet wrapped around pelvis of patient

- if patient persistently hypotensive even after binder and suspect pelvic artery bleed consider IR for embolization

• Long term management requires orthopedic consultation

Complications

• Hypotension from exsanguination
• infection
• Loss of function
• Genitourinary injury

Disposition

Admission