Pelvic fracture management. Dr Gareth Davis, London. [2A02, 2A05, 2A12]
<5% of ED # with majority from RTCs & 50% have associated long bone #.
Mortality 15-50%; risk greatest if hypotensive.
Classification system of most practical use is Young & Burgess [http://www.orthobullets.com/trauma/1030/pelvic-ring-fractures]
Lateral compression # (LC): usually visceral rupture rather than pelvic bleeding.
Vertical shear # (VC): venous plexus injuries common.
AP compression (APC): “open book”, common in motorcyclists. Ligament rupture and venous bleeding +++
Blood goes into retroperitoneal or intraperitoneal spaces. Majority is venous from venous plexus (90%); only 10% from internal iliac artery. VS > APC > LC in terms of blood loss.
USS suffers with intra-observer variability. CT + angiography is diagnostic and therapeutic.
Treatment – movement of patient (log rolls, packaging for transfer) associated with hypotension secondary to clot disruption and loss of tamponade. Scoops can reduce this movement significantly, especially if used in the prehospital setting. Don’t rock & roll!
Pelvic binders work a bit but not a lot! REBOA can be used in zone 3 (base of bifurcation) in the prehospital setting but not as easy to insert as you think.
Manage coagulopathy as per any major trauma. Try to maintain normothermia.