Manajemen Fraktur Pelvis
Manajemen Fraktur Pelvis
Treatment of Patients
with Pelvic Fracture
dr. Nadia Nastassia Ifran, SpOT
Pelvis
Pelvic ring : sacrum and 2
innominates
Innominate formed by the
fusion of ilium, ischium and
pubis
Function of Pelvis
Protection for visceral organs and traversing
neurovascular structures
The site for load transfer between axial skeleton and
lower extremities
Pelvic Fracture
Low energy injuries:
low energy fall, straddle type injury
Result in fractures of individual bones
Trauma patients
Primary survey (ABCDE)
Address life-threatening injuries
Symphyseal diastasis or
vertical displacament
anteriorly and posteriorly;
usually through SI joint, less
commonly through iliac wing
and/or sacrum
CM
Combination of other injury
pattern (LC/VS)
Pre Hospital
Address other life threatening conditions (pelvic
fracture is a result of major force other significant
injuries??)
Oxygen
Large bore I.V. access fluids and analgesic
External compression
Open wounds
Degloving injuries
Swelling in pelvic area
Hemorrhagic shock
External compression
It gives less space for blood to accumulate
Tamponade bleeding sources (fractured bony surface,
ruptured vessels)
Reduce instability of the injured pelvis prevent
further damage to soft tissue and visceral organs
Reduces pain by limiting pelvic movement
Methods
Sheet method
PASG or MAST pants
Commercial/prefabricated devices
Pelvic binder
Hip hugger
Traumatic pelvic orthotic device (T-POD)
Sheet Method
Fold sheet smoothly 12 inch (do not roll)
Place under the patient and centered over greater
trochanter
Wrap and twist ends around pelvis
Pelvic Binder
Emergency Department
HD unstable patients
Leading cause of death in patients with pelvic fracture
Posterior pelvic venous plexus accounts for majority of
bleeding (up to 80%)
Internal arterial injury <20%
HD unstable patients
Damage Control Orthopaedics
Temporary stabilization of pelvis
Fluids resuscitation
Resuscitation in Shock
2 large bore I.V. line (16G or larger)
Administer crystalloid and coloid solution determine
response
Platelets and FFP will be required with massive
transfusions to correct dilutional coagulopathy
Avoid hypothermia! It leads to coagulation problems,
ventricular fibrillation and acid-base disturbance
Emergently placed in HD
unstable patient
Allowing other procedure to be
performed (laparotomy, etc)
Confirmed under fluoroscopy
Indications:
Contraindications:
Pelvic clamps
Developed to control
posterior pelvis
Large percutaneously placed
pins over the SI joint
posteriorly
Ganz C-clamps
Pelvic packing
May aid in tamponade the
beeding
Pelvis should be stabilized
before packing
Packs can be placed pre
peritoneal and
retroperitoneal
Angiography Embolization
Indications:
HD unstable patients following
resuscitation
After external fixation
application
Summary
Pelvic fracture that disturb the pelvic ring integrity is
one of the emergency concern
If the mechanism of injury is severe enough to cause
unstable pelvis then it is also severe enough to cause
other life threatening injury asses other areas!