Pelvic Injury

Pelvic Injury

·        Serious

·        Need to check all midline structures: rectum, bladder, urethra, also ureters, iliac vessels

·        Immediate risk is bleeding. Usually from iliac veins – retroperitoneal

·        Signs and symptoms of pelvic bleeding:

o   Shock (blood loss, visceral damage)

o   Bruising

o   Abrasions

o   Ecchymoses into thigh and perineum

o   Swelling of labia / scrotum, blood at urethral meatus

o   Abdominal tenderness

o   Pain

·        Investigations

o   X-rays essential: AP, inlet, outlet, oblique views.  Always look for pairs of fractures

o   If anterior fracture then must also do x-rays of sacro-iliac joints and lumbar

Fractures

·        Structure and stability:

o  The stability of the pelvic ring depends on both the bony and ligamentous structures

o  The anterior position of the pelvic ring does not participate in normal weight bearing, nor is it essential for maintenance of pelvic stability

o  The posterior arch (sacrum, sacro iliac joint and ilia) all serve as the weight bearing portion of the pelvis

o  The posteriosuperior SI ligaments connecting the iliac tuberosities to the sacrum provide most of the stability to the SI joints

o  Fractures may be unstable or stable (those that don‟t involve the pelvic ring or have minimal displacement of the pelvic ring)

·        Types of fractures:

o  AP compression injury hinges the pelvis open onto the intact posteriosuperior S.I. ligaments. Not grossly unstable

o  Lateral compression. Caused by direct force to iliac crests. May be stable or unstable

o   Vertical shear. Forces through femur directed perpendicularly to the pelvic ring. Causes disruption to the S.I. joint / unimpacted fracture through the sacrum or ilium. Hemipelvis is unstable

o  If >1 fracture then pelvic ring is unstable and up to 25% will have internal injuries.

·        Treatment

o  Quick manoeuvre to ¯ bleeding: internally rotate femurs and tie a towel around the pelvis and pull it tight 

o  Most fractures are stable and can be treated conservatively

o  If unstable will require surgical stabilisation