8/18/2019 Pelvic Fracture 44
1/46
8/18/2019 Pelvic Fracture 44
2/46
Early complications
) Associated conditions (
Delayed complications
8/18/2019 Pelvic Fracture 44
3/46
Early complications
8/18/2019 Pelvic Fracture 44
4/46
Multiple trauma
ull
est
domen
tremities
8/18/2019 Pelvic Fracture 44
5/46
8/18/2019 Pelvic Fracture 44
6/46
Hemorrhage
The most dangerous
&life threatening condition
)hypovolemic shock ( Sources:
Retroperitoneal
)Bone- Small & arge !essels ( Multiple trauma
) "hest- Abdomen- ong bone #x (
8/18/2019 Pelvic Fracture 44
7/46
Epidemiology
•Evaluating Pelvic Hemorrhage (EPH)
Study –724 consecutive pelvic fractures at
Harborvie
•62 %male
• A!erage age $ %
•Mechanism
–Motor !ehicle crash '()
–"ar !ersus pedestrian *+)
–#all ,%.% meters/ ++)
–"rush ')
8/18/2019 Pelvic Fracture 44
8/46
•Hemodynamic shock in 0mergency 1ept .
–Blood pressure234 *()
–5ulse+%4 %4)
–Transfuse in 01 *3)
•Blood re6uirement
– Any 74)
–6 or more units +)
–Range ,4 to +(+units/
•1eath +%)
8/18/2019 Pelvic Fracture 44
9/46
Sign & Symptom
!ack pain
Abdominal pain
S8elling & Echymosis
) #lank 9 Buttock 9 :nguinal 95erineum (
H ypotension & Shock
8/18/2019 Pelvic Fracture 44
10/46
; ray
"#ray :
Soft tissue shado8 displacement
) :nt.obturator< :liopsoas< =luteal #at pad
Bladder < >terus (
C$ scan:
Hematoma
Angigraphy :
8/18/2019 Pelvic Fracture 44
11/46
8/18/2019 Pelvic Fracture 44
12/46
#x type
APC % &S , high risk/
Artery & ?ein :n@.
:liac 9 :liolumbar 9 Sup.=luteal–
:nternal 5udental.
'C ,rare/ #x site 9 ?isceral :n@.
Stable ,!ery rare/
8/18/2019 Pelvic Fracture 44
13/46
Treatment
$ ransfusion
Pel!ic belt
Antishock garment
*eduction & ixation
Angiographic emboliation
8/18/2019 Pelvic Fracture 44
14/46
Thromboembolism
5el!ic bone trauma & :mmobiliation
:psilateral or contralateral
"alf 9 Thigh 9 5el!ic !eins
5roximal thrombosis has
=reatest risk of embolism
8/18/2019 Pelvic Fracture 44
15/46
:ncreased risk of 1?T
+lder age
S pinal cord :n@.
'o8er extremity :n@.
History of 1?T
8/18/2019 Pelvic Fracture 44
16/46
Rate
MR ?enography %')
$hrombosis "ontrast ?enography *3)
1opler Sonography 3)
Pulmonary Embolism * 9 +*)
atal Pulmonary Embo, 4.' 9 +4)
8/18/2019 Pelvic Fracture 44
17/46
5rophylaxy
*outin prophylaxis is mandatory Method is controversial
Drug - Aspirin 9 arfarin
o8 dose Heparin o8 M..Heparin
.echanical devices:
"ompresion stocking #oot pump
"ompresion de!ice thigh & leg
?ena ca!a Clter
8/18/2019 Pelvic Fracture 44
18/46
at Embolism
8/18/2019 Pelvic Fracture 44
19/46
=asterointestinal :n@.
+pen fracture
Deep pel!ic infection
*etroperitoneal absces
Peritonitis
High mortality rate
8/18/2019 Pelvic Fracture 44
20/46
=asterointestinal :n@.
/ ound in perineum
!lood in rectum
More proximal :n@ury ,"ontrast "Tscan/
1irect :n@. ,Bone fragment/
:ndirect :n@. ,0xt.Rot. Streching/
8/18/2019 Pelvic Fracture 44
21/46
Management
0rrigation & Debridment
Early "olostomy
!road spectrum antibiotic
8/18/2019 Pelvic Fracture 44
22/46
=asterointestinal in@.
!+/E' +!S$*AC$0+1
Paralytic :leous
Entrapment in #x site
8/18/2019 Pelvic Fracture 44
23/46
=enitourinary in@.
Men omen
D!erall Rate +E)
8/18/2019 Pelvic Fracture 44
24/46
Bladder
Contusion 2222*upture
*upture - =ross Hematuria
Mortality Rate ** 9 %) 85% E xtra peritoneal
?esico colic Cstula
#oley catheter
15% 0ntera peritoneal
Repair & #oley catheter
8/18/2019 Pelvic Fracture 44
25/46
>rethral :n@.
.en / omen ) ?agina & >rethra (
Blunt < A!ulsion :n@.
"ommonly 1istal to 3rogenital
Diaphragm
- Blood on meatus
$riad # 1istended Bladder - :nability to !oid
*etrograde >rethrography
8/18/2019 Pelvic Fracture 44
26/46
>rethral :n@.
*epairing time is contro!ersial
Primary Repair FF.. More :mpotence rate
Delayed Repair FF.. More Stricture rate
8/18/2019 Pelvic Fracture 44
27/46
Geurologic :n@.
'umbosacral % Sacral pleus 0n4 .
Sciatic 1, (Proneal) 0n4 .
5ost. 5el!ic Ring #x ,?S 4 9 '4) /
Sacral #x ,"ompresion/ #oraminal *7)Medial
to #oramen '()
A5" 9 ?S ,Traction/
8/18/2019 Pelvic Fracture 44
28/46
8/18/2019 Pelvic Fracture 44
29/46
Management
Physical Eamination )Before & After
Reduction (
Early *eduction % iation of
1eurolysis *epair
1er!e graft ?
8/18/2019 Pelvic Fracture 44
30/46
+pen
Rate )
:liac crest 8ound
Rectum & 5erineum 8ound
?aginal 8ound
8/18/2019 Pelvic Fracture 44
31/46
+pen
0liac Crest /ound +ften minor % stable )mortality 4 9 ') (
Sometimes APC 5 &S
)mortality *') (
:rrigation & 1ebridment "ontrol of hemorrhage
8/18/2019 Pelvic Fracture 44
32/46
+pen *ectum % Perineum /ound
.ortality *ate 9 '4)
Hemorrhage
) 5acking 9 0mboliation 90xternal #ixation9
Hemipel!ectomy (
Sepsis ) :rrigation & 1ebridment 9 0arly "olestomy –
5acking the 8ound 9 1ebridment (
8/18/2019 Pelvic Fracture 44
33/46
8/18/2019 Pelvic Fracture 44
34/46
+pen
&aginal 'aceration
Debridment
&*epair
&E xternal #ixation
8/18/2019 Pelvic Fracture 44
35/46
8/18/2019 Pelvic Fracture 44
36/46
5ost Dp. :nfection E)
0ncreased *isk
-Dpen #x
-:lio:nguinal Approach -#ebrile 5atient
Percutaneous Scre
-?ery Rare +pen *eduction
-Got "ommon
8/18/2019 Pelvic Fracture 44
37/46
Treatment
-0rrigation & 1ebridment
-Deep "ulture
- Antibiotic Beeds
-'ea!e the Hard8are if possible
-
E xternal #ixation
8/18/2019 Pelvic Fracture 44
38/46
iation ailure
+ "m 1isplacement
Percutaneous 0liosacral Scre +4)
Sacral #x S: 1x
Prevention:
-Spinopel!ic #ixation
-Scre8 across the Sacrum to far :leum
-Multiple Scre8
8/18/2019 Pelvic Fracture 44
39/46
#ixation #ailure
Percutaneous Sup, Pubic *amus Scre +4)
-0ldery & Dsteoprotic #emale
-Medial & Shaft #x ateral #x
Eternal iator -5in oosening
-5in Tract :nfection
8/18/2019 Pelvic Fracture 44
40/46
Seual Dysfunction
Urethral Vascular
Neruologic
Psychologic Inj.
>nstable & Marked 1isplaced #x
8/18/2019 Pelvic Fracture 44
41/46
.en6s Seual Dysfunction
Posterior 3rethral 0n4 . :
:mpotence Rate '4)
Poorly Scored on Sex 1ri!e
Erection
E @aculation SatisCcation
Eldery 7 8oung
8/18/2019 Pelvic Fracture 44
42/46
/omen6s Seual Dysfunction
Ant, Pelvic *ing
More 1ysfunction
Dyspareunia %7) , 'mmdisplacement /
Decreased 0nterest % +rgasm ')
Dysmenorrhea &aginal Delivery Problem
0ncontinence
8/18/2019 Pelvic Fracture 44
43/46
Dther "omplications
.yositis +ssi9cant *4)
.alunion
>p to 34) in Gon Dperati!e Method
1onunion?
igamentous :n@. may not healed
'o !ack Pain
S: oint :n@. Chronic Pelvic Pain
Sacral 5lexus :n@.
8/18/2019 Pelvic Fracture 44
44/46
"ase Reports
- Acute Compartment Synd . :n =luteal & Thigh comp.
-:luteal Soft $issue 1ecrosis
After Angiographic 0mboliation - !oel Herniation
-!ladder Herniation
:n 5ub. Symphisis 1iastasis
- lail Penis 0n +pen !ook
1ue to Suspensory ig. :n@.
8/18/2019 Pelvic Fracture 44
45/46
8/18/2019 Pelvic Fracture 44
46/46