Figure 31.1
AP pelvis radiographs of a male patient with an anterior compression grade 3 injury before and after application of a pelvic binder and a representative CT image of the same patient
What to Ask
- 1.
What is the patient’s hemodynamic status? (Intrapelvic hemorrhage in these injuries can be fatal.)
- 2.
Are there any open injuries? A pelvic and rectal exam must be performed to rule out vaginal/rectal open fractures.
- 3.
What are the associated injuries?
What to Request
- 1.
CT scan of the pelvis through the level of the lesser trochanter with fine (2 mm) cuts to evaluate the pelvic fracture and identify any occult injuries, such as an associated femoral neck fracture without displacement.
- 2.
Pelvic binder if available
When to Escalate
- 1.
Open fracture – open wounds associated with a lateral compression pelvic injury carry a very high morbidity; they should be emergently identified and treated.
- 2.
Hemodynamic compromise – these injuries carry a very high association with the head and intra-abdominal pathology that must be evaluated with any hemodynamic compromise.
- 3.
If the patient is going to the OR with general surgery, the attending surgeon on call may elect to place an external fixator if possible.Related posts:
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