Injuries around the lower extremity and
joints
Fractures of the pelvis, including
demonstration of pelvic binder
Ghislain Aminake MD
Baptist Hospital Mutengene
Cameroon
Mutengene 14-11-2020
AOA Course–Nonoperative
Fracture Management
Layout
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Objectives
Basic Anantomy
Classification
Pelvis Ring injury : open book injury
Pelvis Binder application
Learning Objectives
 Understand the different steps in the
management of pelvis injury
 Master the technique of application of the
pelvis binder
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Anatomy
 stability comes from
ligament complexes
 Blood supply:
Abdominal aorta, corona
mortis, post. venous
plexus.
 Nerves: Lumbosacral
Plexus, femoral n.,Sciatic
n., obturator n.
Classification
Tile Classification
Type A: Rotationally and vertically stable
Type B: Rotationally unstable , vertically stable
Type C: Rotationally and vertically unstable
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Pelvis Ring injury : Open Book Injury
 Mechanism typically high energy blunt
trauma
 Mortality rate 1-15% for closed fractures,
as much as 50% for open fractures
 Tile type B injury
 High incidence of associated injuries both
ortho and non-ortho
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Open book injury
 Clinical Features
→Presentation
pain,
inability to bear weight,
hemodynamic instability (hypovolemic
shock)
Open Book Pelvis injury
 Clinical features
→ATLS evaluation
primary survey : ABCDE
secondary survey
tertiary survey
Open book pelvis injury
 Imaging
→X-rays
AP view
Inlet/Outlet Views
→ CT scan
Open book pelvis injury
 Treatment
→Resucitation: ATLS principles
→Temporary immobilisation :
Pelvis Binder
External Fixation
Open Book Pelvis Injury
 Treatment
→Definitive treatment
Non-op
① Weight bearing as tolerated
② Bed Rest and Pelvis binder
Operative : ORIF, Percuatneous pinning
Open Book Pelvis injury
 Treatment
① Weight bearing as tolerated
Indications:
Mecanically stable injury :Tile type A
Isolated pubic ramus Fx
Pubis symphisis widening <2,5cm with
intact posterior pelvis ring
Open Book Pelvis injury
 Treatment
① Bedrest and pelvis binder
Indications:
Pelvic diastasis less than 4cm
Take home message
 Save life first
 Look for associated injuries
 Pelvis binder is generally used as a
temporary measure before final Tx