vertical shear pelvic fracture
TRANSCRIPT
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Pelvis Case #10
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33 yo male construction worker p/w extreme pain to the right pelvis and lower back s/p fall from 20 feet off a scaffolding and landing on fully extended right leg. Pt had questionable LOC. Otherwise no other pain
History and PhysicalT 98.5 P 120 BP 107/50
O2 98%Gen: severe distress,
diaphoreticCV: Tachycardic, RR, no
m/r/gPulm: Lungs CTA bilatGI: s/nt/ndExt: right leg shortened
with pain on ROM.GU: blood at urethral
meatus
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Image
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Diagnosis: Vertical Shear Fracture
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ATLS:A,B,Cs with IV, O2, Cardiac Monitor
Address HemorrhageType/Cross for 6 U PRBC
Immobilization of PelvisTrauma imagingEmergent Orthopedic Consult
ED Management
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Most concerning is significant hemorrhage (7-8 U PRBC) into retroperitoneum:Internal iliac branches a.Superior gluteal a.Sacral venous plexus may require Angiography
Assess for concomitant intra-abdominal trauma
Consider GU trauma
Pearls
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Posterior:Ilium, sacrum, SI
Anterior:Symphysis pubis or pubic rami
Vertically oriented anterior and posterior pelvis
Complete Pelvic Floor + posterior SI + sacrospinous and sacrotuberous ligamentsPost. Sacroiliac ligaments Vertical Stability
Unstable Fractures!
Pearls
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Additional Image
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http://lifeinthefastlane.com/education/who-was/eponymous-fractures/
http://online-media.uni-marburg.de/radiologie/kap12.htm
http://www.wheelessonline.com/ortho/malgaigne_fracture_vertical_shear
Simon, Robert, and Scott Sherman. Emergency Orthopedics. New York: McGraw Hill, 2011. 6th Ed.
References