Trauma Pelvis

 

PELVIC TRAUMA dr Indro Wibowo Sejati

 

PURPOSE 

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Knowing types o pe!"i# ra#t$re and %anage%ent Knowing indi#ations and insta!ation te#&ni'$es # #!a%p

 

 A(A  A(AT TOMI

 

 A(A  A(AT TOMI

 

 A(A  A(AT TOMI

 

 A(A  A(AT TOMI

 

 A(AT  A(ATOMI

 

PELVIC 

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Pe!"i# stabi!ity depends on t&e integrity o pe!"i# !iga%ents and bones T&e %ost i%portant and strongest !iga%ents in t&e posterior part is !ig) sa#roi!ia# and i!io!$%bar  In $nstab!e pe!"i# tra$%a #an o##$r !arge b!ood !oss and possib!e #o%p!i#ations in "is#era organs in t&e pe!"i# #a"ity

 

PELVIC *RACTURE 

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Pe!"i# ra#t$res e+posing t&e pe!"i# ring and it #an !ead to instabi!ity T&e degree o instabi!ity depends on w&i#& parts are #$t o t&e ring Me#&ani#a! instabi!ity #an res$!t in &e%odyna%i# instabi!ity w&en a##o%panied by "as#$!ar da%age in t&e pe!"i# #a"ity s&o#, 

 

Pe!"i# ra#t$re Morta!ity -. in ad%itted patient wit& stab!e &ae%odina%i# & ae%odina%i# -/. in patient wit& $nstab!e &ae%odina%i# 

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*RAKT *RAKTUR UR PEL PELV VIS

 

PELV VIS KLASI*IKASI *RAKTUR PEL KLASI*IKASI TILE

TIPE A 0Stab!e1

TIPE 2 Rotationa!!y $nstab!e Verti#a!!y stab!e 0open boo, type1

TIPE C Rotationa!!y and Verti#a!!y Unstab!e

 Young  Yo ung and Burgess proposed a different modification of the original Pennal classification, adding a new category for combined mechanism injuries

 

LAT LATERAL COMPRESSIO( I(3URIES Category Common characteristic

Differentiating characteristic

LC I

Anterior trans"erse ra#t$re 0p$bi# ra%i1

Sa#ra! #o%pression on side o i%pa#t

LC II

Anterior trans"erse ra#t$re 0p$bi# ra%i1

Cres#ent 0i!ia# wing1 ra#t$re

LC III

Anterior trans"erse

Contra!atera! open boo,

ra#t$re 0p$bi# ra%i1

0APC1 inj$ry

 

 A(TEROPOSTERIOR COMPRESSIO( COM PRESSIO( Category  APC 4

Common characteristic Sy%p&ysea! diastasis

Definition S!ig&t widening widening o p$bi# sy%p&ysis and5or S! joint6 stret#&ed b$t inta#t anterior and posterior !iga%ents

 APC 7

Sy%p&ysea! diastasis or anterior "erti#a! ra#t$re

Widened joint8 !iga%ents6 disr$pted S! anterior inta#t posterior !iga%ents

 APC -

Sy%p&ysea! diastasis or anterior "erti#a!

Co%p!ete &e%ipe!"is separation b$t no  joint disr$ption6 #o%p!ete anterior anterior and posterior !iga%ent disr$ption

 

VERTICAL S9EAR A(: COM2I(E: MEC9A(ISM Category

Comm Co mmo on cha harracteris isttic

Defin iniition

VS

Sy%p&ysea! diastasis or

Verti#a! Ve rti#a! disp!a#e%ent anterior!y

anterior "erti#a! ra#t$re

and posterior!y8 $s$a!!y t&ro$g& S! joint8 o##asiona!!y t&ro$g& i!ia# wing and5or sa#r

%$Anterior and5or posterior8 "erti#a! and5or trans"erse #o%ponents

Co%bination o ot&er inj$ry patterns6 LC5VS or LC5APC

CM

Vertical shear mechanism

 

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In a subsequent series, lateral compression !C" injuries were the most common injury pattern, accounting for #$% of the patients, followed by anteroposterior compression &PC" injuries '(%", acetabular fractures $)%", combined mechanism C*" injuries $+%", and ertical shear V-" injuries .%"/ 0ypoolemic 0ypoolemic shoc1 and large blood requirements were more common in patients with ertically unstable &PC type 2 injuries than in those with w ith ertically stable anteroposterior or lateral compression injuries/

 

PELVIC *RACTUR PELVIC *RACTURE E T;PE A(: OUTCOME

 

PELVIC TRAUMA 

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Major tra$%a Po!ytra$%a patients Lie t&reatening 9ae%orr&agi# s&o#, Trai# a##ident

 

MA3OR TRAUMA

 

POL; TRAU TRAUMA MA 9ead C&est  Abdo%en Spine

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Pe!"is E+tre%ities

 

:IA ta#&y#ardia 0&e%odina%i# $nstab!e1 Radio!ogi# = Ro pe!"i# AP8 CT s#an

 

MEC9A(ISM O* I(3UR; 

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low3energy fractures4 genera!!y res$!ting in iso!ated ra#t$res o indi"id$a! bones do not da%age t&e tr$e integrity o t&e ring str$#t$re domestic falls4 ?stradd!e? inj$ry ro% a a!! in t&e bat&t$b8 an etio!ogy re'$ent!y o$nd in t&e e!der!y e !der!y pop$!ation aulsion injuries o t&e %$s#!e apop&yses in s,e!eta!!y i%%at$re patients)

 

MEC9A(ISM O* I(3UR; 

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high3energy fractures4 genera!!y prod$#ing pe!"i# ring disr$ption motor ehicle, .5%6 .5%6 pedestrian8 4/.6 %otor#y#!e8 @.6 a!!s ro% &eig&ts8 @.6 and #r$s&8 . oten res$!t in two or %ore ra#t$res o t&e pe!"i# ring &P force, lateral impacts, ertical shear Penetrating mechanisms4 asso#iated "is#era! and ne$ro"as#$!ar inj$ries

 

P9;SICAL P9;SICAL EBAMI(A EBAMI(AT TIO(

 

PELVIC EBAMI(ATIO( 

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Press posterior and anterior to t&e i!ia# #rest 0anterior posterior stabi!ity1 :oing tra#tion on one !eg wit& pe!"i# i+ation 0"erti#a! stabi!ity1

 

RA:IOLO