Pelvic Fractures: Part 1. Evaluation, Classification, and Resuscitation

Abstract

Pelvic fractures range in severity from low-energy, generally benign lateral compression injuries to life-threatening, unstable fracture patterns. Initial management of severe pelvic fractures should follow Advanced Trauma Life Support protocols. Initial reduction of pelvic blood loss can be provided by binders, sheets, or some form of external fixation, which serve to reduce pelvic volume, stabilize clot formation, and reduce ongoing tissue damage. Persistently unstable patients may benefit from angiography with selective embolization, pelvic packing, or a combination of these interventions. Open pelvic fractures involving the perineum or bowel injury benefit from fecal diversion by colostomy. Trauma team coordination facilitates efficient resuscitative efforts and may affect definitive management by optimizing incision, ostomy, or catheter placement. Established protocols for both open and closed pelvic fractures help to standardize care.

Incidence of Pelvic Ring Fractures in the U.S. Military Population

“…The etiology of pelvic ring fractures can vary from low-energy injuries associated with osteoporosis to high-energy injuries that cause life-threatening, unstable fractures [2]. Different mechanisms of injury have led to peaks of incidence among two different populations (e.g.…”

“…Pelvic ring fractures can result from different mechanisms of injury, such as low-impact falls among the elderly population, and high-energy, traumatic events, such as motor vehicle accidents (MVAs) [1,2]. Pelvic ring fractures are high-risk injuries that require careful evaluation due to significant patient morbidity and mortality associated with damage to major blood vessels, nerves, and organs [2].…”

“…Pelvic ring fractures can result from different mechanisms of injury, such as low-impact falls among the elderly population, and high-energy, traumatic events, such as motor vehicle accidents (MVAs) [1,2]. Pelvic ring fractures are high-risk injuries that require careful evaluation due to significant patient morbidity and mortality associated with damage to major blood vessels, nerves, and organs [2]. Among the military population, the increased use of improvised explosive devices (IEDs) against U.S. soldiers in Iraq and Afghanistan is an additional risk factor that has lead to an increased incidence of complex traumatic pelvis injuries [3].…”

Visage sacro-iliaque percutané pour fracture instable du Bassin de type C 1-2 : à propos d’un cas au CHU de Yaoundé

“…Les fractures du bassin sont des urgences vitales lorsqu'elles entraînent une instabilité de l'anneau pelvien [ 4 , 5 ]. Elles sont inhérentes à la mobilité des individus imposée par l'activité socioprofessionnelle.…”

“…Ces fractures représentent 5% des fractures et surviennent dans le cadre des polytraumatismes dans 20% [ 6 ]. Elles imposent parfois des mesures de stabilisation à la phase primaire comportant un remplissage hémodynamique et une immobilisation du bassin [ 4 ]. La fixation externe en urgence par le fixateur de Hoffman, la pose d'un pantalon antichoc ou un clamp pelvien et plus simplement une traction trans-osseuse permettent dans ces cas de comprimer le bassin et ou de stabiliser les caillots permettant ainsi de franchir le cap de l'urgence initiale, puis de procéder aux explorations nécessaires.…”