MANAGEMENT OF PELVIC

FRACTURE
Respati Suryanto Dradjat
FK Universitas Brawijaya
Malang
• Focuses on high-energy injuries
• Management in both the resuscitative and
reconstructive phases
• Potential complications.
• Pelvic fractures are extremely difficult injuries
to manage, with reported mortality rates of
up to 50%.
• If the retroperitoneal space is open, no
tamponade effect occurs to prevent excessive
bleeding.
injuries to the major vessels and
nerves of the pelvis and the major
viscera, such as the intestines, the
bladder, and the urethra.
• Is there a clear airway?
• Are the lung adequately ventilated?
• Is the patient losing blood?
• Is there an intra abdominal injury?
• Is there a bladder or urethral injury?
• Is the pelvic fractute stable or unstable?
wrapping a bed sheet (or commercially
available binder) around the pelvis and
greater trochanters.
• reduces pelvic volume, stabilizes raw fracture
surfaces, and encourages tamponade.
• Use circumferential pelvic binder in the acute
resuscitation stage because of its ease and
rapidness of application.
• In the operating room, an external fixator can
be applied to maintain stability of the pelvis
while allowing access to the abdomen and
perineum.
Pelvic Clamp
Ro evaluation and classification
CT
• reduction in the transfusion requirements of
patients with unstable pelvic fractures who
were treated with immediate external fixation
• Persistent hypotension after circumferential
pelvic binding, and no other source of bleeding
should be considered for arteriography.
• Hemorrhage frequently results from fracture
surfaces and small vessels in the
retroperitoneum.
• 5% to 10% of patients with pelvic fractures bleed
from arterial sources identified by angiography
and are treated with embolization.
resuscitative phases
 The Decision
• Should be made on the initial physiological
state, do not wait for physiological exhaustion
• Early decision and rapid initial assessment of
internal injuries
• Patient with major exsanguinating injuries will
not survive complex procedure
• Multiple trauma patient are more likely to die
from their intraoperative metabolic failure
• In the 1970s “the Golden Hour”
• rapid diagnosis, surgery, and
resuscitation
• “fix everything now”
• Stable patient
• Borderline Patient
• Unstable patient
• Patient in extremis
 Damage Control Procedure
• Control of hemorrage
• Prevention of contamination
• Protection of further injury
Emergency treatment
• > 90% will have other injuries
• intraabdominal injury (9-11%)
• bladder injury (4-6%)
• renal injury (1-2%)
• urethral injury (2-3%)
• TBI, chest, aorta
reconstructive phases
Illiosacral srew fixation
Plate fixation
TERIMA KASIH