Diferencia entre revisiones de «Pelvic fractures»
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Sin resumen de edición |
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==Pearls== | ==Pearls== | ||
* Pelvic fractures are associated with: | * Pelvic fractures are associated with: | ||
* Hemorrhage requiring transfusion - 35% | * Hemorrhage requiring transfusion - 35% | ||
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* Exception to this is in the elderly (isolated pubic ramus) and athletes (isolated avulsion) | * Exception to this is in the elderly (isolated pubic ramus) and athletes (isolated avulsion) | ||
* Extension of fracture into the rectum or vagina = open fx | * Extension of fracture into the rectum or vagina = open fx | ||
==Fracture Types== | ==Fracture Types== | ||
===Pelvic Ring Disruptions=== | ===Pelvic Ring Disruptions=== | ||
* Lateral Compression | * Lateral Compression | ||
* Usually stable as affected hemipelvis is crushed inward, reducing pelvic volume | * Usually stable as affected hemipelvis is crushed inward, reducing pelvic volume | ||
| Línea 35: | Línea 26: | ||
* Ipsilateral anterior and posterior ring fractures | * Ipsilateral anterior and posterior ring fractures | ||
* High rate of neurovascular injury | * High rate of neurovascular injury | ||
===Other Pelvic Fractures=== | ===Other Pelvic Fractures=== | ||
* Straddle Injury | * Straddle Injury | ||
* Unstable | * Unstable | ||
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* Stable; occur usually in skeletally immature athletes aged 14-17 yrs | * Stable; occur usually in skeletally immature athletes aged 14-17 yrs | ||
* Can rarely occur in association with trauma in adults; if lack of trauma pathological until proven otherwise | * Can rarely occur in association with trauma in adults; if lack of trauma pathological until proven otherwise | ||
===Imaging=== | ===Imaging=== | ||
* Plain films | * Plain films | ||
* AP - Obtain in all unconscious blunt trauma patients | * AP - Obtain in all unconscious blunt trauma patients | ||
| Línea 65: | Línea 50: | ||
* May confuse hemoperitoneum for uroperitoneum | * May confuse hemoperitoneum for uroperitoneum | ||
* If FAST negative but pt is persistently hypotensive consider DPA (aspirate) | * If FAST negative but pt is persistently hypotensive consider DPA (aspirate) | ||
===Management=== | ===Management=== | ||
* Anticipate hypotension | * Anticipate hypotension | ||
* Rapidly detect hemoperitoneum | * Rapidly detect hemoperitoneum | ||
Revisión del 08:46 21 nov 2011
Pearls
- Pelvic fractures are associated with:
- Hemorrhage requiring transfusion - 35%
- Especially with sacroiliac joint disruption
- Intraabdominal injury - 16%
- Bladder/urethra injury - 6%
- Nerve deficits - 15%
- Especially with post. ring fx, upper sacral fracture
- Thoracic aorta rupture - 1.5%
- If pelvic ring is disrupted there are usually two fractures
- Exception to this is in the elderly (isolated pubic ramus) and athletes (isolated avulsion)
- Extension of fracture into the rectum or vagina = open fx
Fracture Types
Pelvic Ring Disruptions
- Lateral Compression
- Usually stable as affected hemipelvis is crushed inward, reducing pelvic volume
- Anteroposterior Compression
- Usually unstable as the iliac wings are forced outward, increasing pelvic volume
- Often assocciated with pelvic and retroperitoneal hemorrhage
- Coincident injuries of the thorax and the abdomen are the rule
- Vertical Shear
- Result from vertically oriented force delivered to the pelvis via the extended femurs
- Unstable; pelvic volume is increased
- Malgaigne Fracture
- Ipsilateral anterior and posterior ring fractures
- High rate of neurovascular injury
Other Pelvic Fractures
- Straddle Injury
- Unstable
- Both rami fractured on both sides or both rami on one side and pubic symphysis diastasis
- High rate of urinary tract and bowel injury
- Avulsion Fracture
- Stable; occur usually in skeletally immature athletes aged 14-17 yrs
- Can rarely occur in association with trauma in adults; if lack of trauma pathological until proven otherwise
Imaging
- Plain films
- AP - Obtain in all unconscious blunt trauma patients
- Inlet - Better defines the pelvic brim
- Outlet - Better defines the sacrum and SI joints
- Judet - Better defines the acetabulum
- CT
- Obtain in all hemodynamically stable blunt trauma pts with pelvic fx on xray
- Exceptions include isolated pubic rami fx, avulsion fx
- Retrograde cystourethrogram
- Obtain (before foley!) if blood at the meatus, high riding prostate, or gross hematuria
- US
- May confuse hemoperitoneum for uroperitoneum
- If FAST negative but pt is persistently hypotensive consider DPA (aspirate)
Management
- Anticipate hypotension
- Rapidly detect hemoperitoneum
- Classify fx pattern as "stable" or "unstable"
- If unstable wrap with sheet or pelvic binder
- Be careful not to over-reduce a lateral compression fx (places increased strain on the post. pelvis)
- Pt's legs, greater trochanters, and patellae should always lie in an anatomical position
- In lateral compression injury the goal is stabilization, not compression
- Assess for associated injuries
- Neurological
- Distal motor weakness (impaired dorsi/plantar flexion of great toe)
- Distal numbness (dorsal and lateral aspects of foot)
- Cauda equina syndrome (perianal anesthesia, loss of sphincter tone)
- Open Fx
- Vaginal bleeding
- Rectal bleeding
Reference
UpToDate, Harwood-Nuss