Pelvic Fracture 44

8/18/2019 Pelvic Fracture 44

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Early complications

) Associated conditions (

Delayed complications


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Early complications


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Multiple trauma

ull

est

domen

tremities


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Hemorrhage

The most dangerous

&life threatening condition

)hypovolemic shock ( Sources:

Retroperitoneal

)Bone- Small & arge !essels ( Multiple trauma

) "hest- Abdomen- ong bone #x (


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Epidemiology

•Evaluating Pelvic Hemorrhage (EPH)

Study –724 consecutive pelvic fractures at

Harborvie

•62 %male

• A!erage age $ %

•Mechanism

–Motor !ehicle crash '()

–"ar !ersus pedestrian *+)

–#all ,%.% meters/ ++)

–"rush ')


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•Hemodynamic shock in 0mergency 1ept .

–Blood pressure234 *()

–5ulse+%4 %4)

–Transfuse in 01 *3)

•Blood re6uirement

– Any 74)

–6 or more units +)

–Range ,4 to +(+units/

•1eath +%)


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Sign & Symptom

!ack pain

Abdominal pain

S8elling & Echymosis

) #lank 9 Buttock 9 :nguinal 95erineum (

H ypotension & Shock


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; ray

"#ray :

Soft tissue shado8 displacement

) :nt.obturator< :liopsoas< =luteal #at pad

Bladder < >terus (

C$ scan:

Hematoma

Angigraphy :


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#x type

APC % &S , high risk/

Artery & ?ein :n@.

:liac 9 :liolumbar 9 Sup.=luteal–

:nternal 5udental.

'C ,rare/ #x site 9 ?isceral :n@.

Stable ,!ery rare/


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Treatment

$ ransfusion

Pel!ic belt

Antishock garment

*eduction & ixation

Angiographic emboliation


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Thromboembolism

5el!ic bone trauma & :mmobiliation

:psilateral or contralateral

"alf 9 Thigh 9 5el!ic !eins

5roximal thrombosis has

=reatest risk of embolism


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:ncreased risk of 1?T

+lder age

S pinal cord :n@.

'o8er extremity :n@.

History of 1?T


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Rate

MR ?enography %')

$hrombosis "ontrast ?enography *3)

1opler Sonography 3)

Pulmonary Embolism * 9 +*)

atal Pulmonary Embo, 4.' 9 +4)


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5rophylaxy

*outin prophylaxis is mandatory Method is controversial

Drug - Aspirin 9 arfarin

o8 dose Heparin o8 M..Heparin

.echanical devices:

"ompresion stocking #oot pump

"ompresion de!ice thigh & leg

?ena ca!a Clter


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at Embolism


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=asterointestinal :n@.

+pen fracture

Deep pel!ic infection

*etroperitoneal absces

Peritonitis

High mortality rate


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=asterointestinal :n@.

/ ound in perineum

!lood in rectum

More proximal :n@ury ,"ontrast "Tscan/

1irect :n@. ,Bone fragment/

:ndirect :n@. ,0xt.Rot. Streching/


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Management

0rrigation & Debridment

Early "olostomy

!road spectrum antibiotic


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=asterointestinal in@.

!+/E' +!S$*AC$0+1

Paralytic :leous

Entrapment in #x site


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=enitourinary in@.

Men omen

D!erall Rate +E)


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Bladder

Contusion 2222*upture

*upture - =ross Hematuria

Mortality Rate ** 9 %) 85% E xtra peritoneal

?esico colic Cstula

#oley catheter

15% 0ntera peritoneal

Repair & #oley catheter


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>rethral :n@.

.en / omen ) ?agina & >rethra (

Blunt < A!ulsion :n@.

"ommonly 1istal to 3rogenital

Diaphragm

- Blood on meatus

$riad # 1istended Bladder - :nability to !oid

*etrograde >rethrography


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>rethral :n@.

*epairing time is contro!ersial

Primary Repair FF.. More :mpotence rate

Delayed Repair FF.. More Stricture rate


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Geurologic :n@.

'umbosacral % Sacral pleus 0n4 .

Sciatic 1, (Proneal) 0n4 .

5ost. 5el!ic Ring #x ,?S 4 9 '4) /

Sacral #x ,"ompresion/ #oraminal *7)Medial

to #oramen '()

A5" 9 ?S ,Traction/


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Management

Physical Eamination )Before & After

Reduction (

Early *eduction % iation of

1eurolysis *epair

1er!e graft ?


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+pen

Rate )

:liac crest 8ound

Rectum & 5erineum 8ound

?aginal 8ound


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+pen

0liac Crest /ound +ften minor % stable )mortality 4 9 ') (

Sometimes APC 5 &S

)mortality *') (

:rrigation & 1ebridment "ontrol of hemorrhage


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+pen *ectum % Perineum /ound

.ortality *ate 9 '4)

Hemorrhage

) 5acking 9 0mboliation 90xternal #ixation9

Hemipel!ectomy (

Sepsis ) :rrigation & 1ebridment 9 0arly "olestomy –

5acking the 8ound 9 1ebridment (


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+pen

&aginal 'aceration

Debridment

&*epair

&E xternal #ixation


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5ost Dp. :nfection E)

0ncreased *isk

-Dpen #x

-:lio:nguinal Approach -#ebrile 5atient

Percutaneous Scre

-?ery Rare +pen *eduction

-Got "ommon


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Treatment

-0rrigation & 1ebridment

-Deep "ulture

- Antibiotic Beeds

-'ea!e the Hard8are if possible

-

E xternal #ixation


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iation ailure

+ "m 1isplacement

Percutaneous 0liosacral Scre +4)

Sacral #x S: 1x

Prevention:

-Spinopel!ic #ixation

-Scre8 across the Sacrum to far :leum

-Multiple Scre8


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#ixation #ailure

Percutaneous Sup, Pubic *amus Scre +4)

-0ldery & Dsteoprotic #emale

-Medial & Shaft #x ateral #x

Eternal iator -5in oosening

-5in Tract :nfection


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Seual Dysfunction

Urethral Vascular

Neruologic

Psychologic Inj.

>nstable & Marked 1isplaced #x


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.en6s Seual Dysfunction

Posterior 3rethral 0n4 . :

:mpotence Rate '4)

Poorly Scored on Sex 1ri!e

Erection

E @aculation SatisCcation

Eldery 7 8oung


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/omen6s Seual Dysfunction

Ant, Pelvic *ing

More 1ysfunction

Dyspareunia %7) , 'mmdisplacement /

Decreased 0nterest % +rgasm ')

Dysmenorrhea &aginal Delivery Problem

0ncontinence


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Dther "omplications

.yositis +ssi9cant *4)

.alunion

>p to 34) in Gon Dperati!e Method

1onunion?

igamentous :n@. may not healed

'o !ack Pain

S: oint :n@. Chronic Pelvic Pain

Sacral 5lexus :n@.


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"ase Reports

- Acute Compartment Synd . :n =luteal & Thigh comp.

-:luteal Soft $issue 1ecrosis

After Angiographic 0mboliation - !oel Herniation

-!ladder Herniation

:n 5ub. Symphisis 1iastasis

- lail Penis 0n +pen !ook

1ue to Suspensory ig. :n@.


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Documents

Pelvic Fracture 44