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Management of Musculoskeletal Injuries in the Trauma Patient pp 143–163Cite as

Pelvic Fractures

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Abstract

Hemodynamically unstable pelvic injuries are potentially lethal. Early diagnosis and intervention are critical to prevent morbidity and mortality. Current classifications schemes are based on the integrity of the posterior pelvic ring since this is the source of cancellous bony bleeding, venous hemorrhage, and arterial injury. In the workup of these patients, particular attention should be directed towards the patient’s age, systolic blood pressure, and need for blood products—since these have been correlated with increased mortality risk. In the last decade, damage-control resuscitation strategies have evolved from the civilian trauma experience with subsequent refinements in administration of blood products. In addition to prognostic indicators such as presenting systolic blood pressure <90 mmHg, age >60, low initial hematocrit, and a significant base deficit, the surgeon should also be aware of the more “dangerous” and biomechanically unstable radiographic fracture patterns—lateral compression type III (LC III), anteroposterior types II/III (APC II/III), and vertical shear (VS) injuries. However, patients can still present with physiologic instability due to minimally displaced pelvic fractures; hemodynamic instability is often independent of fracture pattern.

In the pelvic trauma patient, mechanical instability is important to identify early; however, physiologic instability is more critical and the ultimate cause of mortality. The modern management of pelvic fractures should be based on logical steps to identify, prevent, and decrease hemodynamic instability in order to improve outcome. When the emphasis is on rapid hemostatic control and physiologic restoration, deaths that were once considered “unavoidable” can, in many cases, be avoided.

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Authors and Affiliations

  1. Department of Orthopaedics, Hip and Pelvis Institute, Saint John’s Health Center, 2001 Santa Monica Blvd., Suite 1090, Santa Monica, CA, 90404, USA

    Navid M. Ziran MD

  2. Department of Orthopaedics, Swedish Medical Center, Englewood, CO, USA

    Wade R. Smith MD, FACS

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  1. Navid M. Ziran MD
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Correspondence to Navid M. Ziran MD .

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Editors and Affiliations

  1. Department of Orthopaedics, Swedish Medical Center, Englewood, Colorado, USA

    Wade R. Smith

  2. Department of Orthopedics, Denver Health Medical Center, Denver, Colorado, USA

    Philip F. Stahel

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Ziran, N.M., Smith, W.R. (2014). Pelvic Fractures. In: Smith, W., Stahel, P. (eds) Management of Musculoskeletal Injuries in the Trauma Patient. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8551-3_7

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