Pelvis Case #10

33 yo male construction worker p/w extreme pain to the right pelvis and lower back s/p fall from 20 feet off a scaffolding and landing on fully extended right leg. Pt had questionable LOC. Otherwise no other pain

History and PhysicalT 98.5 P 120 BP 107/50

O2 98%Gen: severe distress,

diaphoreticCV: Tachycardic, RR, no

m/r/gPulm: Lungs CTA bilatGI: s/nt/ndExt: right leg shortened

with pain on ROM.GU: blood at urethral

meatus

Image

Diagnosis: Vertical Shear Fracture

ATLS:A,B,Cs with IV, O2, Cardiac Monitor

Address HemorrhageType/Cross for 6 U PRBC

Immobilization of PelvisTrauma imagingEmergent Orthopedic Consult

ED Management

Most concerning is significant hemorrhage (7-8 U PRBC) into retroperitoneum:Internal iliac branches a.Superior gluteal a.Sacral venous plexus may require Angiography

Assess for concomitant intra-abdominal trauma

Consider GU trauma

Pearls

Posterior:Ilium, sacrum, SI

Anterior:Symphysis pubis or pubic rami

Vertically oriented anterior and posterior pelvis

Complete Pelvic Floor + posterior SI + sacrospinous and sacrotuberous ligamentsPost. Sacroiliac ligaments Vertical Stability

Unstable Fractures!

Pearls

Additional Image

http://lifeinthefastlane.com/education/who-was/eponymous-fractures/

http://online-media.uni-marburg.de/radiologie/kap12.htm

http://www.wheelessonline.com/ortho/malgaigne_fracture_vertical_shear

Simon, Robert, and Scott Sherman. Emergency Orthopedics. New York: McGraw Hill, 2011. 6th Ed.

References