trauma
Pelvic Ring Injury
advanced
6 min
28 marks
6 questions
Clinical Scenario
A 35-year-old male motorcyclist presents following a high-speed collision. He is hypotensive (BP 80/50) with tachycardia (HR 130). GCS is 14 (confused). The pelvis is unstable on examination. Paramedics have applied a pelvic binder. There is blood at the urethral meatus. He is receiving IV fluids via large bore cannulae.
AP pelvis radiograph showing APC-III (open book) injury with symphysis pubis diastasis >2.5cm and widening of the left sacroiliac joint. The hemipelvis is externally rotated indicating complete posterior ring disruption. Pelvic binder in situ.
Source: Educational radiograph of an APC-III pelvic ring injury • OrthoVellum Medical Education Team • OrthoVellum Educational Use
Questions
Question 1 (5 marks)
Classify this pelvic injury using both Young-Burgess and Tile classifications. Describe the implications for hemorrhage.
Question 2 (5 marks)
Describe your immediate resuscitation priorities and the hemorrhage control algorithm.
Question 3 (4 marks)
There is blood at the urethral meatus. What associated injuries must you assess for?
Question 4 (5 marks)
The patient stabilizes after angioembolization. Describe your definitive fixation strategy.
Question 5 (5 marks)
What are the indications for emergent interventions? Describe REBOA, pelvic packing, and angioembolization.
Question 6 (4 marks)
What complications and long-term outcomes would you counsel the patient about?
Exam Day Cheat Sheet
Must Mention
- •Pelvic binder at GREATER TROCHANTERS (not iliac crests)
- •Blood at meatus = DO NOT catheterize until retrograde urethrogram
- •MTP 1:1:1 ratio; avoid crystalloid boluses
- •80% venous (packing), 20% arterial (angio)
- •Posterior ring fixation is priority (SI screws)
- •APC injuries respond best to binder (reduces volume)
Common Pitfalls
- •Pelvic binder at iliac crests (should be at trochanters)
- •Urethral catheter with blood at meatus
- •Repeated pelvic spring test (increases bleeding)
- •Crystalloid boluses (dilutional coagulopathy)
- •Anterior-only fixation for unstable (Type C) injury
- •Operating before physiological optimization