Open book pelvic fracture: Difference between revisions
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==Background== | ==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}} | |||
==Clinical Features== | ==Clinical Features== | ||
* pelvic/Hip pain | *pelvic/Hip pain | ||
* Unstable pelvis | *Unstable pelvis | ||
* hypotension if large amounts of bleed | *hypotension if large amounts of bleed | ||
* Consider concomitant GU injury | *Consider concomitant GU injury | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Abdominal trauma DDX}} | {{Abdominal trauma DDX}} | ||
== | ==Evaluation== | ||
[[File:Picture4.jpg|thumb|]] | [[File:Picture4.jpg|thumb|]] | ||
* Unstable pelvis on exam | *Unstable pelvis on exam | ||
* Xr pelvis in acute trauma setting | *Xr pelvis in acute trauma setting | ||
* CT Pelvis | *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 immediately then obtain X-ray when patient is stable | *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 | *Long term management requires orthopedic consultation | ||
==Complications== | ==Complications== | ||
* Hypotension from exsanguination | *[[Hypotension]] from exsanguination | ||
* infection | *infection | ||
* Loss of function | *Loss of function | ||
* Genitourinary injury | *Genitourinary injury | ||
==Disposition== | ==Disposition== | ||
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==References== | ==References== | ||
<references/> | |||
[[Category: | [[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