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Early complications

(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%

.Hemodynamic shock in Emergency Dept


Blood pressure<90
27%

Pulse>130
30%

Transfuse in ED
29%

Blood requirement
Any
80%

or more units
41% 6

Range
(0 to 171

units)
Death
13%

Sign & Symptom


Back pain
Abdominal pain
Swelling & Echymosis
Flank Buttock Inguinal
(Perineum
Hypotension & Shock

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

Increased risk of DVT


Older age

.Spinal cord Inj


.Lower extremity Inj
History of DVT

Rate
MR Venography

35%

Thrombosis Contrast Venography 29%


Dopler Sonography

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)

Indirect Inj. (Ext.Rot. Streching)

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

Post. Pelvic Ring Fx (VS 40 50% )

Sacral Fx (Compresion)
to Foramen 57%
APC VS (Traction)

Foraminal 28%
Medial

Management
Physical Examination
Before & After
(Reduction

Early Reduction & Fixation of Fx


Neurolysis
Repair
? Nerve graft

Open Fx
Rate

4%

Iliac crest wound


Rectum & Perineum wound
Vaginal wound

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

( Packing the wound Debridment

Open Fx
Vaginal Laceration
Debridment
Repair
&
External Fixation

&

Post Op. Infection 6%


Increased Risk
Open Fx
IlioInguinal Approach
Febrile Patient
Percutaneous Screw
Very Rare
Open Reduction
Not Common
-

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

Men,s Sexual Dysfunction


. :Posterior Urethral Inj
Impotence Rate 50%
Poorly Scored on
Sex Drive
Erection
Ejaculation
Satisfication
Eldery > Young

Women,s Sexual Dysfunction


Ant. Pelvic Ring Fx
More Dysfunction
Dyspareunia 38% ( > 5mm
displacement )
Decreased Interest & Orgasm
Dysmenorrhea
Vaginal Delivery Problem
Incontinence

45%

Other Complications
Myositis Ossificant

20%

Malunion
Up to 90% in Non Operative Method

?Nonunion
Ligamentous Inj. may not healed

Low Back Pain


.SI Joint Inj

Chronic Pelvic Pain


.Sacral Plexus Inj

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-

.Due to Suspensory Lig. Inj

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