Pelvic Fractures

PELVIC FRACTURES

Tile's Classification
Type A : Stable
Type A1 : Fractures not involving ring; avulsion injuries
Type A2 : Stable, minimal displacement (# at only one point in ring)
Type A3 : Transverse fractures of sacrum and coccyx
Type B : Rotationally unstable, vertically and posteriorly stable
Type B1 : External rotation instability; open-book injury
Type B2 : Internal rotation instability; lateral compression injury
Type B3 : Bilateral rotationally unstable injury
Type C : Rotationally, posteriorly and vertically unstable
Type C1 : Unilateral injury
Type C2 : Bilateral injury, one side rotationally unstable, one side vertically unstable
Type C3 : Bilateral injury, both sides completely unstable

Mechanism of Injury
Anteroposterior force
Lateral compression force
External rotation abduction force
Shear force

Examination and Management
Check ABCs and resuscitate accordingly
AP-lateral pelvic compression test
Palpation of the posterior aspect of the pelvis may reveal a large haematoma, a gap through the disrupted fracture area, or dislocation of the sacroiliac joint.
Palpation of the pubic symphysis may reveal a gap
Inspect the perineum for open wounds --- open fractures!
Check for neurologic deficits in the lower limbs due to lumbosacral plexus and nerve roots injuries
Check for urethral injury: blood at the meatus, scrotal haematoma, high-riding prostate (ie, perform a PR examination)

X-rays
AP and lateral views of the pelvis
Lateral c-spine and CXR in view of major trauma
Pelvic inlet and outlet views should not be done at the A&E (to avoid delay in management). Inform Ortho Registrar on call early.

Management
Resuscitate patient according to ATLS principles
In cases of failure to restore blood pressure despite intravenous fluids and blood transfusions, exclude concomitant intra-abdominal injuries.
Inform orthopaedic registrar-on-call if still unable to maintain blood pressure, KIV for emergency external fixation of pelvis
Type B and C cases :
Admit to Department of Orthopaedic Surgery if isolated pelvic injuries/other orthopaedic injuries
Admit to Dept of General Surgery if associated cardiothoracic, intra-abdominal or unstable head injuries
Type A cases :
If pain can be managed at the A&E, consider discharging patient in wheelchair and TCU Ortho SOC 1/52
If pain unrelenting despite IM analgesics, admit to Ortho Dept