PELVIC TRAUMA

dr Indro Wibowo Sejati

PURPOSE
Knowing types of pelvic fracture and management
Knowing indications and instalation techniques c clamp

ANATOMI

ANATOMI

ANATOMI

ANATOMI

ANATOMI

PELVIC
Pelvic stability depends on the integrity of pelvic ligaments and
bones
The most important and strongest ligaments in the posterior part is
lig. sacroiliac and iliolumbar
In unstable pelvic trauma can occur large blood loss and possible
complications in viscera organs in the pelvic cavity

PELVIC FRACTURE
Pelvic fractures exposing the pelvic ring and it can lead to
instability
The degree of instability depends on which parts are cut off
the ring
Mechanical instability can result in hemodynamic instability
when accompanied by vascular damage in the pelvic cavity
shock

Pelvic fracture
Mortality
3% in admitted patient with stable haemodinamic
38% in patient with unstable haemodinamic

FRAKTUR PELVIS

KLASIFIKASI FRAKTUR PELVIS

KLASIFIKASI TILE

TIPE A
(Stable)

TIPE B
Rotationally unstable
Vertically stable (open
book type)

TIPE C
Rotationally
and Vertically
Unstable

Young and Burgess proposed a different modification of the original

Pennal classification, adding a new category for combined mechanism
injuries

LATERAL COMPRESSION INJURIES

Category Common
characteristic

Differentiating
characteristic

LC I

Anterior transverse Sacral compression on

fracture (pubic rami) side of impact

LC II

Anterior transverse Crescent (iliac wing)

fracture (pubic rami) fracture

LC III

Anterior transverse Contralateral open book

fracture (pubic rami) (APC) injury

ANTEROPOSTERIOR COMPRESSION
Category

Common characteristic

Definition

APC 1

Symphyseal diastasis

Slight widening of pubic symphysis

and/or Sl joint; stretched but intact
anterior and posterior ligaments

APC 2

Symphyseal diastasis or
anterior vertical fracture

Widened Sl joint,
disrupted anterior ligaments;
intact posterior ligaments

APC 3

Symphyseal diastasis or
anterior vertical

Complete hemipelvis separation but no

joint disruption; complete anterior and
posterior ligament disruption

VERTICAL SHEAR AND

COMBINED MECHANISM
Category

Common characteristic

Definition

VS

Symphyseal diastasis or
anterior vertical fracture

Vertical displacement anteriorly

and posteriorly, usually through
Sl joint, occasionally through
iliac wing and/or sacrum

CM

Anterior and/or posterior,

vertical and/or transverse
components

Combination of other injury patterns;

LC/VS or LC/APC

Vertical shear
mechanism

 In a subsequent series, lateral compression (LC) injuries

were the most common injury pattern, accounting for 41% of
the patients, followed by anteroposterior compression (APC)
injuries (26%), acetabular fractures (18%), combined
mechanism (CM) injuries (10%), and vertical shear (VS)
injuries (5%). Hypovolemic shock and large blood
requirements were more common in patients with vertically
unstable APC type 3 injuries than in those with vertically
stable anteroposterior or lateral compression injuries.

PELVIC FRACTURE TYPE AND

OUTCOME

PELVIC TRAUMA
Major trauma
Polytrauma patients
Life threatening
Haemorrhagic shock
Traffic accident

MAJOR TRAUMA

POLY TRAUMA
Head
Chest
Abdomen
Spine
Pelvis
Extremities

DIAGNOSIS
History
Physical examination
Radiologic

DIAGNOSIS
Every lower abdominal trauma and inferior extrimity consider
pelvic fracture
Notice mechanism of injury
Clinical examination :
Pelvic lesion/lower abdominal trauma
Pelvic Tenderness
Unstable in palpability
Leg length discrepancy
Rectal examination & blood in mue
Hipotensi & tachycardia (hemodinamic unstable)
Radiologic : Ro pelvic AP, CT scan

MECHANISM OF INJURY
low-energy fractures: generally resulting in isolated
fractures of individual bones
do not damage the true integrity of the ring structure
domestic falls: "straddle" injury from a fall in the bathtub, an
etiology frequently found in the elderly population
avulsion injuries of the muscle apophyses in skeletally
immature patients.

MECHANISM OF INJURY
high-energy fractures: generally producing pelvic ring
disruption
motor vehicle, 57%; pedestrian, 18%; motorcycle, 9%; falls
from heights, 9%; and crush, 4%
often result in two or more fractures of the pelvic ring
AP force, lateral impacts, vertical shear
Penetrating mechanisms: associated visceral and
neurovascular injuries

PHYSICAL EXAMINATION

PELVIC EXAMINATION
Press posterior and
anterior to the iliac crest
(anterior posterior
stability)
Doing traction on one leg
with pelvic fixation
(vertical stability)

RADIOLOGIC
Patient transportable Ro
pelvic AP
CT scan
3 dimensional CT

OUTLET AND INLET VIEW

EMERGENCY MANAGEMENT
Comprehensive
Evaluation
Treatment
Priorities
Other life threatening injuries
Retroperitoneal bleeding

RETROPERITONEAL BLEEDING
Resucitation
Fracture stabilization
Pelvic volume
Angiography + embolization
Exploration + packing

PELVIC STABILIZATION
Reduce pelvic cavity
tampon
Pelvic sling,
External fixation
Internal fixation

EXTERNAL COMPRESSION WITH A BED

SHEET TO REDUCE PELVIC VOLUME

EXTERNAL FIXATION

PELVIC C CLAMP

POSTERIOR C-CLAMP CX:

INFERIOR GLUTEAL ARTERY AND
SCIATIC NERVE DAMAGE

PELVIC C CLAMP

PELVIC C CLAMP
C clamp will compress the SI joints gap
Apply traction before tightening the C clamp
Traction of the afected leg first before tightening the C
clamp in vertical shearing pelvic injury !

PASIEN DENGAN C CLAMP

Check the c clamps position radiographically
Use a firm bed for easier mobilization
Check the tightness of the c clamps bolt and its
attachment to the pelvic bone.
Check the wound at the pin insertion.
C clamp removal
Stable haemodynamic condition.
Planning for definitive treatment of the pelvic injury.

Angiography
Source of the bleeding
Embolization
Guide for surgical procedure

PREPERITONEAL PACKING

THANK YOU