Open book pelvic fracture: Difference between revisions
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*Results in tears of the strong pelvic ligaments that hold the pelvis bones together | *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 | *Large arteries pass near these ligaments and can get torn resulting in massive blood loss | ||
{{Pelvic fracture types}} | |||
==Clinical Features== | ==Clinical Features== | ||
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==Complications== | ==Complications== | ||
*[[Hypotension]]from exsanguination | *[[Hypotension]] from exsanguination | ||
*infection | *infection | ||
*Loss of function | *Loss of function | ||
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==References== | ==References== | ||
<references/> | |||
[[Category:Orthopedics]] | [[Category:Orthopedics]] | ||
Latest revision as of 22:28, 17 March 2021
Background
- Results from an anteroposterior compression injury to the pelvis
- Often seen in elderly falls vs MVA or other high speed trauma
- Causes disruption of pubic symphysis and the pelvis opens like a book
- 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
Pelvic fracture types
- Acetabular pelvic fractures
- Open book pelvic fracture
- Straddle pelvic fracture
- Pelvic avulsion fracture
Clinical Features
- pelvic/Hip pain
- Unstable pelvis
- hypotension if large amounts of bleed
- Consider concomitant GU injury
Differential Diagnosis
Abdominal Trauma
- Abdominal compartment syndrome
- Diaphragmatic trauma
- Duodenal hematoma
- Genitourinary trauma
- Liver trauma
- Pelvic fractures
- Retroperitoneal hemorrhage
- Renal trauma
- Splenic trauma
- Trauma in pregnancy
- Ureter trauma
Evaluation
- Unstable pelvis on exam
- Xr pelvis in acute trauma setting
- CT Pelvis
Management
- 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/sheet immediately then obtain X-ray when patient is stable
- 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