AO basic course

1. AOTrauma Principles Course
Rogier Simmermacher, NL
Michael Miranda, US
Pelvic fractures

2. Pelvic fractures
• Introduction
• Emergency assessment and management
• Standard assessment
• Classification
• Treatment options
• Conclusions

3. At the end, able to describe
• Which PE findings affect outcome
• Appropriate X-ray evaluation
• Describe treatment algorithm
• Hemo-dynamic stable/unstable patient

4. Functions of the pelvis
• Connects spine to lower limbs
• Supports trunk
• Transmits forces applied to trunk or limbs
• Protects organs
• Provides passage for vessels, nerves, and muscles

5. Integrity and stability of pelvic ring are
essential

6. It takes high energy to create such
damage...

7. ...so bone is not of primary importance.
Life is!
Therefore assessment in suspected pelvic ring fracture is
according to ATLS (advanced trauma life support)

8. Primary assessment
• Assessment of circulation includes inspection and
physical examination

9. Primary assessment
• Assessment of circulation includes a standard x-ray
• Reveals up to 90% of fractures

10. Primary assessment
Vital parameters Airway
Breathing
Circulation
stable unstable
Disability (GCS)
Exposure/environment

11. A hemodynamically unstable patient
• Exclude other sources
• Open wound
• Hemothorax
• Hemoabdomen
• Long-shaft bone fractures

12. If the pelvis is the source, then its…
Massive blood loss is:
• Mostly venous
• Due to posterior disruption
• Supported by enlarged
compartment

13. Emergency treatment
Reduce compartment
Stabilize pelvis pelvic clamp
external fixator
Surgical tamponade
Embolization
MAST (military antishock trousers)

14. Pelvic clamp or external fixator

15. Emergency treatment

16. Emergency treatment
Stop bleeding otherwise
Stabilize pelvis
Surgical tamponade laparotomy (dcs)
retroperitoneum
Embolization
MAST

17. Stable patient, open fracture
Aggressive treatment:
• Resuscitation
• Quick diagnostics
• Debridement
• Primary internal fixation
• Direct repair organs
• Copious irrigation
• Planned reoperations

18. Stable patient, closed fracture
• There is time for additional
diagnostics including:
- X-rays
- Pelvic organs
- Neurology

19. Additional radiology
INLET OUTLET

20. Additional radiology
CT scan
?

21. Pelvic organs
• Urethra/prostate
• Rectum
• Vagina
• Sphincter/others

22. Pelvic organs
• Urethra/prostate
• Rectum
• Vagina
• Sphincter/others

23. Pelvic organs
• Urethra/prostate
• Rectum
• Vagina
• Sphincter/others

24. Neurologic examination

25. Müller AO Fracture Classification 61-

26. Read the fracture (x-ray)

27. 61-A (50–70%) intact ring

28. 61-B (20–30%) partial posterior stability,
rotational unstable

29. 61-B (10–20%) anterior and posterior
instability, rotational unstable

30. Classification
• Young & Burgess
• Mechanism of injury
• 4 types

31. Anterior-posterior compression

32. Lateral compression

33. Vertical shear

34. Treatment principles
• Resuscitate patient (ATLS)
• Evaluate pelvic organs
• Thorough examination of fracture(s)
• Make a plan

35. Treatment options—nonoperative/operative
• Operation rarely needed
• Anterior stabilization
• Stabilization of entire ring

36. Operative treatment options
• External fixation
• Internal fixation
- Screws
- Plates
• Combinations

37. Summary
Due to high-energy trauma:
• First, save patient’s life
• More than just a bony injury
• Stabilization of paramount importance
• Many might be treated nonoperatively