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(Associated conditions
Delayed complications
Early complications
Multiple trauma
kull
hest
bdomen
xtremities
Hemorrhage
The most dangerous
life threatening condition
(hypovolemic shock )
:Sources
Retroperitoneal
(Bone- Small & Large vessels
Multiple trauma
(Chest- Abdomen- Long bone Fx
&
)
)
Epidemiology
Evaluating Pelvic Hemorrhage (EPH)
Study
consecutive pelvic fractures at 724
Harborview
male % 62
Average age = 34
Mechanism
Motor vehicle crash
57%
Car versus pedestrian
21%
Fall (>3.3 meters)
Crush
5%
11%
Pulse>130
30%
Transfuse in ED
29%
Blood requirement
Any
80%
or more units
41% 6
Range
(0 to 171
units)
Death
13%
X ray
:X-ray
Soft tissue shadow displacement
Int.obturator, Iliopsoas, Gluteal Fat
pad
(Bladder , Uterus
:CT scan
Hematoma
:Angigraphy
Fx type
APC & VS ( high risk)
.Artery & Vein Inj
Iliac Iliolumbar Sup.Gluteal
.Internal Pudental
LC (rare)
.Fx site Visceral Inj
Stable Fx (very rare)
Treatment
Transfusion
Pelvic belt
Antishock garment
Reduction & Fixation
Angiographic embolization
Thromboembolism
Pelvic bone trauma & Immobilization
Ipsilateral or contralateral
Calf Thigh Pelvic veins
Proximal thrombosis has
Greatest risk of embolism
Rate
MR Venography
35%
9%
Pulmonary Embolism
Fatal Pulmonary Embo.
2 12%
0.5 10%
Prophylaxy
Routin prophylaxis is mandatory
Method is controversial
Drug : Aspirin Warfarin
Low dose Heparin
Low M.W.Heparin
: Mechanical devices
Compresion stocking
Foot pump
Compresion device thigh & leg
Vena cava filter
Fat Embolism
.Gasterointestinal Inj
Open fracture
Deep pelvic infection
Retroperitoneal absces
Peritonitis
High mortality rate
.Gasterointestinal Inj
Wound in perineum
Blood in rectum
More proximal Injury
Direct Inj.
(Contrast CTscan)
(Bone fragment)
Management
Irrigation & Debridment
Early Colostomy
Broad spectrum antibiotic
.Gasterointestinal inj
BOWEL OBSTRACTION
Paralytic Ileous
Entrapment in Fx site
.Genitourinary inj
Men > Women
Overall Rate
16%
Bladder
Contusion Rupture
Rupture : Gross Hematuria
Mortality Rate 22 34%
Extra peritoneal 85%
Vesico colic fistula
Foley catheter
Intera peritoneal 15%
Repair & Foley catheter
.Urethral Inj
Men > Women
(Vagina & Urethra
)
.Blunt , Avulsion Inj
Commonly Distal to Urogenital
Diaphragm
Blood on meatus Triad
- Distended Bladder
Inability to void Retrograde Urethrography
.Urethral Inj
Repairing time is controversial
Primary Repair .. More Impotence rate
Delayed Repair .. More Stricture rate
.Neurologic Inj
.Lumbosacral & Sacral plexus Inj
.Sciatic N. (Proneal) Inj
Sacral Fx (Compresion)
to Foramen 57%
APC VS (Traction)
Foraminal 28%
Medial
Management
Physical Examination
Before & After
(Reduction
Open Fx
Rate
4%
Open Fx
Iliac
OftenCrest
minor Wound
& stable Fx
(mortality 0 5%
Sometimes APC VS
(mortality 25%
Irrigation & Debridment
Control of hemorrhage
)
)
Open Fx
Rectum & Perineum Wound
Mortality Rate 44 50%
Hemorrhage
Packing Embolization External Fixation
( Hemipelvectomy
Sepsis
Irrigation & Debridment Early Colestomy
Open Fx
Vaginal Laceration
Debridment
Repair
&
External Fixation
&
Treatment
Irrigation & Debridment Deep Culture Antibiotic Beeds Leave the Hardware if possible External Fixation -
Fixation Failure
> 1 Cm Displacement
Percutaneous Iliosacral Screw
Sacral Fx > SI Dx
: Prevention
Spinopelvic Fixation
Screw across the Sacrum to far Ileum
Multiple Screw
-
10%
Fixation Failure
Percutaneous
Sup. Pubic Ramus Screw
Eldery & Osteoprotic Female
Medial & Shaft Fx > Lateral Fx
External Fixator
Pin Loosening
Pin Tract Infection
10%
Sexual Dysfunction
Urethral
Vascular
Neruologic
.Psychologic Inj
Unstable & Marked Displaced Fx
45%
Other Complications
Myositis Ossificant
20%
Malunion
Up to 90% in Non Operative Method
?Nonunion
Ligamentous Inj. may not healed
Case Reports
.Acute Compartment Synd.In Gluteal & Thigh comp
Gluteal Soft Tissue NecrosisAfter Angiographic Embolization
Bowel Herniation Bladder Herniation In Pub. Symphisis Diastasis
Flail Penis In Open Book Fx-