Pelvic Fractures

For those of you who missed Dr. Ken Will's presentation this morning on Pelvic Fractures, here are some take-home points:

• The pelvis is a ring - if you see one fracture, there is a high likelihood of another fracture (almost certainly if there is more than 1 cm displacement)

• Pelvic fractures result from significant force and are associated with other significant injuries -  such as intra-abdominal injuries, diaphragm rupture, aortic transection, and urogenital injuries
• Diagnosis of pelvic fracture begins with physical exam - complaints of pain/tenderness 92-100% sensitive, plain pelvic film only 64% sensitive
• The retroperitoneum can easily hold 4 liters of blood, therefore pelvic fractures can cause significant hypotension - especially if they involve the sacro-iliac joint
• Anterior fractures (pubic rami) are less likely to cause hypotension but are associated with urethral and bladder injuries - need uretrhragram followed by cystogram in stable patients

• In patient with pelvic fracture, compression of the pelvic ring is therapeutic and provides some tamponade for bleeding.  This can be done with ext-fix, pelvic binder, or simply a sheet

• In an unstable patient it is important to determine if bleeding is intra-peritoneal vs. retroperitoneal - FAST is only useful if it is positive, DPL (open, supraumbilical) is 98% sensitive 
• If bleeding is intra-peritoneal - patient should go to OR
• If bleeding is retroperitoneal - proceed to angio as 15% may be arterial in nature and amenable to embolization