0071643192.pdf

■ Oblique (Judet) views better define acetabulum fractures.
■ When one part of the pelvic ring has been fractured, always look for a
second fracture or opening. Double ring fractures are unstable.

TREATMENT

■ Nondisplaced fractures can be treated with bed rest while displaced frac-
tures require ORIF.
■ Hip dislocations should be reduced as soon as possible in attempt to restore
blood supply to femoral head. Fragments of acetabulum may prohibit
reduction.
■ Bleeding into the retroperitoneal space commonly results from injury to
venous plexus and small veins and may be life-threatening.
■ Patients with pubic symphysis widening should be treated with pneumatic
antishock garment, pelvic binder (such as bed sheets wrapped around the
pelvis), or external fixation to minimize the volume of the pelvis which
will help control bleeding.
■ In patients with hemorrhagic shock, angiography can help control bleeding
through transarterial embolization. This may not stop the bleeding because
often the bleeding is venous. Indications for embolization include:
■ Persistent hypovolemia/hypotension after treatment of other sources of
bleeding
■ 4 units PRBC/24 hours or 6 units PRBC/48 hours
■ Large pelvic hematoma on CT

HIP DISLOCATION

Hip dislocations may be anterior(due to an anterior and a medial force applied
to the abducted leg), central(direct impact through acetabulum) or posterior
(posterior force through a flexed knee).

Posterior Hip Dislocation

Typically result from a head-on MVC with the knee hitting the dashboard
and the body moving forward over a fixed femur; often associated with poste-
rior wall/lip fractures of the acetabulum (see Figure 3.16)

EXAM/DIAGNOSIS

■ Extremity is shortened, internally rotated, and adducted.
■ X-ray is confirmative.

TREATMENT/COMPLICATIONS

■ Closed reduction under conscious sedation
■ Sciatic nerve injury may occur.

A 30-year-old male arrives in the ED after a 10-foot fall with perineal/pelvic

pain and inability to void. Rectal examination reveals a high-riding prostate.

What is the most appropriate next step?

Obtain a retrograde urethrogram to rule out the presence of a urethral injury.

This should always follow more critical resuscitative procedures, but must be

done prior to Foley placement.

TRAUMA

A

B

FIGURE 3.16. Poste-

rior hip dislocation.

(Reproduced, with permis-

sion, from Tintinalli JE,

Kelen GD, Stapczynski JS.

Emergency Medicine: A

Comprehensive Study

Guide,6th ed. New York:

McGraw-Hill, 2004:1724.)

Perform a bimanual vaginal

exam on all women with

pelvic fractures. Vaginal

lacerations are most

commonly seen with anterior

pelvic fractures and usually

require operative repair.