pelvic fractures

EMST / ATLS Principles

Usually polytrauma

- 10% mortality

Aims

1. Volume replacement

2. Reduce pelvic ring

3. Stop exsanguination

- external stabilisation / surgery / embolisation

Associated Local Injuries

Arterial bleeders

Anatomy

Unusual anatomic convergence of ilium, pubis and ischium

- covered entirely by hyaline cartilage

- except at acetabular fossa, which is the site of attachment of the ligamentum teres

- deepened by peripheral fibrocartilage labrum

2 column theory (Letournel and Judet)

Anterior Column 

- superior pubic ramus

- anterior acetabular wall, anterior dome

APC compression

Indications

Non Operative

- < 2.5 cm displacement

- indicates SS and ST intact

- nil posterior opening

Operative

1.  > 2.5 cm

- single anterior plate through Pfannelstiel incision

2.  Posterior SIJ disruption

- reduction and posterior stabilisation

- usually with SI screws

Anatomy

Pelvis is a true ring

- any anterior fracture must have a posterior injury as well

- integrity of the posterior sacroiliac complex is key

Bony Anatomy

2 innominate bones + sacrum

Symphysis pubis < 5mm

SI joint 2-4 mm