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    Pelvic Trauma: DR Indro Wibowo Sejati

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    Indro Wibowo
    This document discusses pelvic trauma, including types of pelvic fractures and their management. It describes the anatomy of the pelvis and how pelvic stability relies on intact ligaments and bones. Unstable pelvic fractures can cause significant blood loss and organ injury. Various classification systems of pelvic fractures are presented, including the Tile classification system categorizing fractures as stable or unstable. Diagnosis involves history, physical exam, and radiologic imaging. Emergency management priorities include evaluating for other injuries, stabilizing fractures to reduce blood loss, and treating retroperitoneal bleeding through resuscitation, pelvic stabilization methods like C-clamps or external fixation, angiography, and possible surgical exploration.

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    Pelvic Trauma: DR Indro Wibowo Sejati

    Uploaded by

    Indro Wibowo
    220 views42 pages
    This document discusses pelvic trauma, including types of pelvic fractures and their management. It describes the anatomy of the pelvis and how pelvic stability relies on intact ligaments and bones. Unstable pelvic fractures can cause significant blood loss and organ injury. Various classification systems of pelvic fractures are presented, including the Tile classification system categorizing fractures as stable or unstable. Diagnosis involves history, physical exam, and radiologic imaging. Emergency management priorities include evaluating for other injuries, stabilizing fractures to reduce blood loss, and treating retroperitoneal bleeding through resuscitation, pelvic stabilization methods like C-clamps or external fixation, angiography, and possible surgical exploration.

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    trauma pelvis

    Original Title

    Trauma Pelvis

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    This document discusses pelvic trauma, including types of pelvic fractures and their management. It describes the anatomy of the pelvis and how pelvic stability relies on intact ligaments and bones. Unstable pelvic fractures can cause significant blood loss and organ injury. Various classification systems of pelvic fractures are presented, including the Tile classification system categorizing fractures as stable or unstable. Diagnosis involves history, physical exam, and radiologic imaging. Emergency management priorities include evaluating for other injuries, stabilizing fractures to reduce blood loss, and treating retroperitoneal bleeding through resuscitation, pelvic stabilization methods like C-clamps or external fixation, angiography, and possible surgical exploration.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    220 views42 pages

    Pelvic Trauma: DR Indro Wibowo Sejati

    Uploaded by

    Indro Wibowo
    This document discusses pelvic trauma, including types of pelvic fractures and their management. It describes the anatomy of the pelvis and how pelvic stability relies on intact ligaments and bones. Unstable pelvic fractures can cause significant blood loss and organ injury. Various classification systems of pelvic fractures are presented, including the Tile classification system categorizing fractures as stable or unstable. Diagnosis involves history, physical exam, and radiologic imaging. Emergency management priorities include evaluating for other injuries, stabilizing fractures to reduce blood loss, and treating retroperitoneal bleeding through resuscitation, pelvic stabilization methods like C-clamps or external fixation, angiography, and possible surgical exploration.

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
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    of 42

    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

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