Pelvic Fracture and

Soft tissue Injury

Fractures
 Introduction

• The bony pelvis consist of the ilium, ischium, and

pubis which form an anatomic rings with the sacrum
• Pelvic injuries range from the benign to
life threatening
 Why this is such a problem
Pelvic fracture frequently involve injury to
organs contained within the bony pelvis
• 90% will have other injuries
• index for intraabdominal injury (9-11%)
• index for bladder injury (4-6%)
• index for renal injury (1-2%)
• index for urethral injury (2-3%)
• other: chest, aorta
 Pelvic fracture → focus on 4
topics!

• Hemorrhage - Life threatening

• Genitourinary injury (GU)
• Deformity- orthopedics
• Neurologic injury
 Pelvic fracture : Hemorrhage!!

• Open-book injury(A)
- pubic symphysis separation
• Sprung injury(C)
- pubic symphysis + SI joint
separation
• Open pelvic fracture
- penetrating to skin,bowel..
 Pelvic fracture : GU complication
• Straddle fracture----→
-direct force to pubis
-all 4 rami fracture:
bladder rupture, urinary
tear,hematuria…..

• Malgaigne’s fractrue→
-vertical shearing force
-usually falls

• Bucket Handle Fracture--→

-lateral compressive force with an
upward rotation component.
Pelvic fracture : Neurologic disorder
Sacrum fracture –direct blow to sacrum

Acetabular fracture
 Management of Pelvic Fracture

As with any trauma patient, ATLS and the ABCs

must be given first priority.
Management :
- Hemodynamically Unstable patient
- Hemodynamically Stable patient
Primary Survey: ABC’s

Airway maintenance with cervical

spine protection
Breathing and ventilation
Circulation with hemorrhage control
Disability: Neurologic status
Exposure/environment control:
undress patient but prevent
hypothemia
Hemorrhage Control
Pelvic Containment
Sheet
Pelvic Binder
External Fixation

Angiography

Laparotomy

Pelvic Packing
Sheet Application
Pelvic Binder
Pelvic Binders
Pelvic Clamp
 Anti-shock Clamp (C-clamp)

Better posterior pelvis stabilization

Allows abdominal access

Apply in fluoro/OR?

Combined with packing

Ertel, W et al, JOT, 2001

 Anti-shock Clamp (C-clamp)

Better posterior pelvis stabilization

Allows abdominal access

Apply in fluoro/OR?

Combined with packing

Ertel, W et al, JOT, 2001

Avoid Overcompression in Sacral Fxs!
Pelvic Packing

▪ Ertel, W et al, JOT, 2001

▪ Pohlemann et al, Giannoudis et al,
Emergent laparotomy

When to warrant urgent laparotomy

- Hypotension and gross blood in abdomen;
continuous intra-abdominal bleeding
- Diagnostic Peritoneal Lavage(+) –aspiration
of gross blood.
- Evidence of intestinal perforation
- Angiographic embolization is unsuccessfull
RUANG LINGKUP
BEDAH
SOFT TISSUE INJURY
 STRAIN OTOT

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SPRAIN LIGAMEN ANKLE
SPRAIN LIGAMEN KNEE
RUPTUR TENDON
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