1 / 29

Pelvic Fractures 2 nd Northern Trauma Network Conference

Pelvic Fractures 2 nd Northern Trauma Network Conference. P Fearon Consultant Orthopaedic Trauma Surgeon - RVI. Overview. Identify the priorities of life saving, limb saving, and disability-limiting surgery Outline the general and local factors affecting decision-making

aitana
Download Presentation

Pelvic Fractures 2 nd Northern Trauma Network Conference

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Pelvic Fractures2nd Northern Trauma Network Conference P Fearon Consultant Orthopaedic Trauma Surgeon - RVI

  2. Overview • Identify the priorities of life saving, limb saving, and disability-limiting surgery • Outline the general and local factors affecting decision-making • Importance of teamwork

  3. Orthopedic and trauma surgeons naturally concentrate on the fracture • It is vital to realise that there are other factors that may dominate decision making in the management of a particular fracture

  4. Injury Patient Care team Resources

  5. Injury • Fracture • Vascular injury • Compartment syndrome • Open wound • Crush injury • Nerves • Patient • Previous Condition • Age (physiologic) • Diagnoses • Medications! • Other injuries • Physiologic response • Expectations/needs • Resources • OR • Instruments • Implants • Imaging • ICU • (Other Patients) • Care Team • Surgeon • Assistants • Anesthesia • Other specialties • OR nurses • Postoperative • Rehabilitation • Social supports

  6. Classification systems Survivors Non-survivors

  7. Non-survivors Early Death Late Death Haemorrhage Brain injury Sepsis MOF Bleeding # bones, venous plexus, arterial injury, extra-pelvic sources

  8. Survivors • Mental health problems • Chronic pain • Pelvic obliquity • Leg length discrepancy • Gait abnormalities • Sexual & urological dysfunction • Long term unemployment

  9. Pre-Hospital • Goals:- • Early suspicion • Identification – no need to spring/log roll • Management

  10. Pelvic immobilisation should be routine MOI Symptoms Clinical findings • deformity, bruising or swelling over the bony prominences, pubis, perineum or scrotum. • Leg length discrepancy or rotational deformity of a lower limb (without fracture in that extremity) may be evident. • Wounds over the pelvis or bleeding from the patient's rectum, vagina or urethra may indicate an open pelvic fracture. • Neurological abnormalities may also rarely be present in the lower limbs after a pelvic fracture.

  11. Ease of application Access for intervention Shown just as good as external fixators

  12. Prevent re-injury from pelvic motion (clot disruption) • Tamponade bleeding pelvic bones & vessels • Decrease pain • Decrease pelvic volume (lesser)

  13. ED • Resuscitation / Management • MHP • WBCT – trauma series • TEAM • TEAM TEAM TEAM

  14. Illustrated case • 29 yr female • Motor cyclist • GCS 14/15 • BP 90/40 • Hr 110 • PV bleeding • Binder applied

  15. Pathway • Resuscitation on going via CT scanner

  16. All bets off! Team Huddle – Senior Decision making Modify Plan

  17. Aorta stented • Evaluation of coeliac • Common hepatic • Left hepatic • Both internal iliac • Left pudendal branch embolised (anterior division of internal iliac)

  18. Prehospital • ED • ITU & anaesthetics • Ortho • Gen Surg • HBP • CT/radiology • Interventional radiology • Urology • Rehab • Pain team • Sexual dysfunction clinic • Clinical psychology Holistic Approach Improve disability

  19. How much blood loss from pelvic #? • WBV • (true pelvic vol 1.5L, but ↑ with disruption) • Retroperitoneal space 5L • Loose tamponade effect/disruption parapelvic fascia • Escape into peritoneum & thighs

  20. AttachmentSize ? Arterial Bleeding • MOI • Open fractures • Elderly patients (gluteal injuries) • Sacrum/SIJ, symphyseal separation–gluteal, pudendal • CT scan – vascular blush/large haematoma≡sig bleed Head on collisions Jumpers

  21. Binder MHP Trauma CT Urology Coordinated Team Approach Surgery Pelvic fixation Holistic Rehab

  22. Isolated haemodynamically unstable pelvic trauma uncommon • Associated injuries due to high MOI • Resuscitation/intervention team based with better understanding & cooperative team working – surgeons included

  23. Thank you

More Related