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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.
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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