Acetabular Fractures-When They Should Be Operated?

For most displaced acetabulum fractures, surgical reduction is indicated with an aim to decrease the incidence of posttraumatic arthritis.

It also permits the patient to return to normal function earlier than nonoperative treatment.

Nonoperative treatment used in a minority of displaced acetabulum fractures. Indications for nonoperative treatment are based on

• Patient condition
• Fracture configuration
• Congruence of the hip joint.

Nonoperative treatment is reserved for patients with nondisplaced fracture, those with tolerable incongruity or displacement, and those in whom surgery is contraindicated. Read more

Complications of Pelvic Fractures

Apart from excessive  bleeding that results from the injury there are many other complications of pelvic fracture which can be directly related injury or as an indirect result. There are other complications which may be related to the treatment.

Complications related To Treatment

Most complications of extenral fixation are the result of pin loosening or infection, and inadequacies of the reduction and fixation. Improper insertion and location of fixation pins in the ilium usually results in early loss of fixation. This leads to pain, loss of reduction, and pin-track infection. Read more

Pelvic Fractures-Clinical and Radiograhic Assessment

Before treating pelvic disruption it is prudent to characterize the injury by its clinical and radiologic features.Clinical and Radiographic assessment of the pelvic fracture victim. Patient should be cilnically examined to look for open wounds, deformities, neurovascular assessment, and uogenital and rectal injury

Radiologic evaluation is carried out by plain xrays (anteroposterior, inlet, outlet, Judet views), computed tomography, fluoroscopy and stress views. In case of need specialized imaging like 3D CT, angiogram, magnetic resonance imaging can be done. Read more

Pelvic Fractures-An Outline of Management of Urologic Injury

A Foley’s Catheter is routinely used to document urinary output as a crucial determinant of adequate volume resuscitation in trauma.

In the presence of a major pelvic fracture, urinary catheterization requires special requires special consideration.

The incidence of concomitant injury to the bladder or urethra is about 20 percent.

if there is any suspicion of a urethral injury in male patients, it is advisable to obtain a urethrogram because Attempts to pass a catheter blindly through a partially disrupted male urethra can aggravate a partial tear and result in a stricture, incontinence, or impotence.

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Mechanisms of Injury to the Pelvic Ring

Injury patterns correlate with the vector of the provocative blow. The force vectors and pelvic injury patterns also correlate with the anticipated patterns of additional injuries to the abdomen, intrapelvic contents, chest, and head, as well as with the potential for significant hemorrhage. Read more

Pelvic Fracture-Asessment, Emergency Management and Definitive Treatment

In history of substantial trauma of any form, whether it is motor vehicular accident or fall from height should always alert the physician or health worker to rule out all life threatening conditions. As per protocol patient is assessed for airway, breathing and circulation at the sit of accident.

A head to toe examination is carried out to look for any gross injury in any other part of body.

Pelvis is tested by direct palpation,Pelvic Compression and Distraction Tests.

In case of injury the pelvis would reveal tenderness. If compressssion or distraction tests are positive for pelvis, it indicates instability of the pelvis.

If there is an overt bleeding , a pressure bandage should be applied. Pelvis should be quickly and temporarily stabilized by wrapping sheet a tightly around it and securing it with a clamp. Read more

Pelvic Fractures In Elderly Persons

Increasing number of aged people is having a profound impact on pelvic fracture management. As the number of elderly people increases, so would be old patients with increasing number of injuries.

Pelvic trauma in young individuals occur due to severe trauma in young individuals. However, the elderly people can get fractures with minor trauma due to weakened skeletal framework as a result of osteoporosis.The elderly experience higher mortality and late morbidity than younger patients with comparable injuries. Read more

Urethral and OtherVisceral Injuries With Pelvic Trauma

Visceral injuries are a potential source of life-threatening complications in a pelvic fracture. Injury to the lower urinary tract is a common consequence of a disruption of the anterior pelvic ring, and it can involve the ureter or, more commonly, the bladder and urethra.

Urogenital system injury (injury to urethra, bladder, kidney) occurs in as many as 25% of all cases involving disruption of the pelvic ring.

It is more common with bilateral pubic arch injury. Potential sites of visceral injury with a pelvic fracture. other potential sites of injury are

• Large and small Intenstines
• Bladder and urethra
• Vagina
• Rectum
• Other intraabdominal structures

Read more

Open Pelvic Fractures

Open pelvic trauma has been associated with high mortality in the past. Recent studies have suggested that mortality is similar to to the closed injuries. Pelvis fracture is an emergency situation itself. If associated with open wounds, there is considerable danger of bleeding to death if immediate medical services are not available.

Open fracture can result from the wound due to external force or the broken bone cutting the skin from inside out.

The principal sites for the open fracture and associated wounds are:

Rami: Perineal laceration, Urethra or bladder injury
Sarcum: Presacral laceration, rectal laceration
Ilium: Blunt trauma, missile, small bowel laceration Read more

Pelvic Fractures-Associated Blood Loss and Therapeutic Intervention

At the time of a traumatically induced pelvic fracture, some degree of hemorrhage is inevitable. The principal sites of bleeding are outlined. The anticipated sites of major hemorrhage correlate with the region of the pelvis fracture, the vector of the provocative blow, and the magnitude of pelvic displacement.

For example, a displaced fracture of the posterior ilium that exists through the roof of the greater sciatic notch is likely to be associated with an injury to the superior gluteal vessels. Read more

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