Trauma pelvis

Latifah
 Anatomi
• Ring Structure of three Bones—
Two innominate bones (ilium,
ischium, pubis) and the sacrum.
• Anteriorly -pubic and ischial rami
connected with the symphysis
pubis.
• Posteriorly- sacrum and the two
innominate bones are joined at
the sacroiliac joint by:
- interosseous sacroiliac
ligaments,
- anterior and posterior
sacroiliac ligaments,
- sacrotuberous ligaments,
- sacrospinous ligaments,
- iliolumbar ligaments.
Rosen's Emergency Medicine Eighth Edition
John A. Marx MD, Robert S. Hockberger MD and Ron M. Walls MD
 https://bluestarr.wordpress.com/2012/01/19/urinary-system/
Anatomi
1. Organ visceral- VU, ureters,
uretra,colon,uterus,vagina,
prostat
2. Perdarahan (a. gluteal
superior,a. Pudenda internal,
pelvic veins)

http://doctorstock.photoshelter.com/image/I0000jIX1zJjr810
3. Persarafan- Lumbosacral
plexus, sciatic nerve,
Lumbosacral trunk, L5 nerve
root, cauda equina
Physical Examination
1. Assess for other life-threatening injuries using Primary Survey
(ABCDE).
2. Manual manipulationp  pelvic injuries.
3. Rectal examination—high-riding prostate may indicate urethral
tear. Palpation of the sacrum for irregularity.
3. Vaginal examination —bleeding or lacerations indicating open
fractures.
5. Perineal skin —lacerations may indicate open fracture, scrotal,
abial hematoma, swelling or ecchymosis, flank hematoma
Assessment of pelvic stability
manual manipulation
Young-Burgess Classification of Pelvic Fractures
Based on the direction of forces causing fracture, associated
instability of pelivs, mechanism of injury
1. Lateral compression
2. Anterior–posterior compression
3. Vertical shear
4. Combined mechanism
 Y-B: Lateral Compression
• I Sacral crush injury on ipsilateral side
• II Sacral crush injury with disruption of posterior SI ligaments; iliac
wing fracture may be present (rotationally unstable)
• III LC-I or LC-II injury on side of impact, contralateral side external
rotation (open-book injury) (rotationally unstable)

Browner BD: Skeletal Trauma: Basic Science, Management, and Reconstruction, 3rd ed.
 Y-B: Anteroposterior Compression
• I Slight widening of pubic symphisis (<2,5cm) and/or aneterior SI joint;
intact posterior SI ligaments
• II Symphysis diastasis >2.5 cm, sacrospinous, sacrotuberous and anterior
SI ligament disruption, intact posterior SI ligaments (rotational instability)
• III Symphysis diastasis >2.5 cm, with complete disruption of the anterior
and posterior SI ligament, (complete rotational and vertical instability)

Browner BD: Skeletal Trauma: Basic Science, Management, and Reconstruction, 3rd ed.
• Y-B: Vertical Shear- symphyseal diastasis or vertical
displacement anteriorly and posteriorly, usually through the
SI joint, occasionally through the iliac wing and/or sacrum

• Y-B: Combined mechanism- combination of other injury

patterns. LC/VS most common.

Browner BD: Skeletal Trauma: Basic Science, Management, and Reconstruction, 3rd ed.
Tile's Classification of Pelvic Fractures
• Type A —Stable
• Type B —Partially stable
• Type C —Unstable

A B

C Pelvis - Orthopaedic Trauma Association

 Tile’s- Type A
• Stable, posterior arch intact;
• A1 Avulsion injury
• A2 Iliac wing or anterior arch fracture caused by a direct
blow
• A3 Transverse sacrococcygeal fracture

A1 A2 A3
Pelvis - Orthopaedic Trauma Association
 Tile’s- Type B
• Partially Stable (Incomplete Disruption of Posterior Arch)
• Rotationally unstable but vertically stable.
• B1 Open book injury (external rotation)
• B2 Lateral compression injury (internal rotation)
B1
Pelvis - Orthopaedic Trauma Association

B2 B2
Clasification of Pelvic Fractures. Zahid Askar. B3
• B3 Bilateral – bilateral open book; B1/B2; B2/B2. Pelvis - Orthopaedic Trauma Association
 Presenting Signs and Symptoms
• Pelvic pain
• Swelling of the pelvic area
• Hematoma in the area of the pelvic bone
• Pelvic deformity
• Perineal ecchymoses, scrotal or labial hematomas
• Blood at the urethral meatus
Longitudinal traction is a first-line method.

.
Pelvic Fractures- Emergency Medicine Second Edition. James G. Adams MD. Copyright © 2013, 2008 by Saunders, an imprint of Elsevier Inc
Stabilization
• Pelvic Binder
- Commercial device that can be
used for prehospital and emergent
stabilization of pelvic fractures.
- In APC (“open-book”) fractures,
use of a pelvic binder will close the
ring and tamponade venous
bleeding.

Fractures of Acetabulum and Pelvis- Campbell's Operative Orthopaedics.

Guyton, James L.; Perez, Edward A.. Published January 2, 2013. Pages 2777-
2828.e5. © 2013.
• Stable pelvic fracture- nonoperative treatment

• Unstable pelvic fracture

- External fixation- anterior external fixator/ Pelvic-clamps
- Open Reduction and Internal Fixation
 Nonoperative Treatment
• Stable nondisplaced or minimally displaced fractures may be treated
nonoperatively (isolated pubic ramus fractures, B1-1).
• Bed rest 2-3 weeks
• Lateral compresion fractures- weight bearing only on the unaffected
side.
• Vertically unstable fractures in which there is a contraindication to
operative treatment may be treated with skeletal traction.
 Angiography / embolization
• Contrast material injected through
the femoral artery on the less-injured
side or via the upper extremity.
• Transcatheter embolization with
thrombogenic coils, foam, or
spherules
• Indicated for patients who remain
HD unstable following resuscitation,
application of external fixator, and
after other sources of bleeding
(abdomen, chest) are ruled out.
• Arterial source of bleeding is present
in only 10% to 15% of patients.
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