Open Pelvic Fractures
May 5, 2008 by Dr Arun Pal Singh
Filed under 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
Irrespective of the mechanisms of injury, the presence of an open wound is usually due to tremendous energy dissipation on the pelvic ring resulting in an unstable fracture dislocation.
In open fractures of the pelvis, external fixation remains the most common method of stabilization, improved wound care and newer techniques have made internal fixation an option.
Several different strategies for definitive pelvic fixation may be considered, depending on the type and site of the wound, the magnitude of contamination, the fracture pattern, and the resources of the surgical team.
Minor contamination with small or large wound
- Acute external fixation
- Percutaneous internal fixation
- Acute internal fixation inserted through the open wound
Moderate contamination
- Acute external fixation
- Secondary, optimally percutaneous, internal fixation
Heavy contamination
- Acute debridement
- External fixation
- Deferral of internal fixation until the risk of a deep infection is minimized, if possible at all
When the open wound is in proximity to the perineum or anal sphincter, or when it involves viscera, a diversion colostomy is necessary to divert feces away from the open wound.
Tags: closed injury, fracture dislocation, ilium, open pelvic fracture, Pelvic fracture, pelvic trauma, rami, sarcum, wound
I am trying to find out something about the sacrum. I was told I might have a possible fracture of my sacrum. Can you tell me anything about this. I was not sure just what the “sacrum” is and I forgot to ask the doctor. Could you please send me an explanation on this subject. I fell the other day and have been in pain ever since. I had an x-ray taken, and now he wants me to have a bone scan. Thank you.
Hi Marlyn,
Sacrum is a part of spine. It commences below lumber spine or lower back and has got 5 vertebrae which are fused with each other. Its second vertebra articulates with iliac bones to form a ring called pelvis.
To have an idea check out the diagram here
http://boneandspine.com/spine/lumbar-spine/lumbar-spinemorphologic-functional-anatomy/
It is not clear why your doctor has suggested you a bone scan.
If you are still confused about the issue, ask your doctor about it and why the particular investigations are being done.
I hope that helps.
Arun Pal Singh