ESTABILISHED STANDARD PREHOSPITAL
TRANSPORT PROTOCOL AND EMERGENCY
DEPARTMENT MANAGEMENT ALGORITHMS
11% PREALGORITHM
7% POST ALGORITHM
HIGH ENERGY TRAUMA
1-MOTORCYCLE COLLISION
2-CAR VS PEDESTRIAN
3-FALL OVER 4.6 M
4-LATERAL IMPACT
5-MVC WITH VEHICLE INCOMPATIBILITY
MEN > WOMEN
33YEARS
SUSPICION OF PELVIC FRACTURE
1-MECHANISM OF FRACTURE
EMERGENCY MEDICAL
PROFESSTIONAL INFORMATION
2-PATIONT PRESENTATION
3-PHYSICAL EXAM
1- SHORTENING OF LOWER LIMB
VERTICAL SHEAR
2-LATERAL ROTATION
ROTATIONAL INSTABILITY
3-PRINEAL ECHYMOSIS AND
FLANK SCROTAL,LABIAL
4-RECTAL BLEEDING
5-VAGINAL BLEEDING
6-URETHRAL BLEEDING
PHYSICAL EXAM
1-LATERAL COMPRETION (ILIAC WING)
2-ANTEROPOSTERIOR COMPRETION
MAKE PAIN OR GROSS INSTABILITY
3-GAP OR PUBIS SYMPHYSIS
SEPARATION
4-VAGINAL AND RECTAL EXAM
HIGH POSISION PROSTAT=URETRA TEAR
RECTAL EXAM IN CHILD ONLY WHEN
HEMORAGE
5-NEROLOGIC EXAM
SCIATIC NERVE AND
LUMBOSACRAL
BRANCHS IS NEAR Fx
BULBOCAVVERNUS REFLEX
MOTOR FUNCTION
IMAGING
1-STANDARD AP
COLINEAR PUBIS SYMPHYSIS
AND SACRAL SPINOUS PROCESS
1-DISPLASMENT OF SACRUM OR SI JOINT
2-L5 SPINOUS PROCESS FRACTURE
3-PUBIS SYMPHYSIS DIASTASIS OR
WITH DISPLACEd RAMI Fx
PELVIC INLET PROJECTION
45 DEGREE CODAL
1-LATERAL ROTATION OF HEMIPELVIC
2-OPEN SI JOINT
3-IMPACT SACRAL ALA
4- AP DISPLACEMENT OF HEMIPELVIC
PELVIC OUTLET PROJECTION
45 DEGREE CEPHALAD
1- SACRUM
2-SI JOINT
3-VERTCAL DISPLACEMENT
4- UNSTABLE HEMIPELVIS
FLEXION EXTENTION DEFORMITY
IS SEEN IN 3 XRAY BUT IS BETTER
OUT LET VIEW( ROTATION POINT
IS TYPICALY AT POSTERIOR RING)
CT SCAN
2-3 mm AXIAL SECTION IS GOOD
FOR MAJORITY OF SIGNIFICANT
INJURIES
GOOD FOR THREE DIMENTIONAL
RECONSTRACTIONS
CT IS INDICATED
DOUBT ABOUT THE DIAGNOSIS
IN PLAIN RADIOGHRAPH
OPERATIVE INTERVENTION IS
PLANNED
CT SCANNING CHANGED
INJUREY CLASSIFICATION IN
15%
MANAGEMENT IN 3% OF
PATIENTS
CT AIDS
DECISION FOR OPERATION
AND CONSERVATIVE
IMPROVE OPERATION
APPROACH SELECTION
MANY TRAUMA CENTERS
OPTAIN CT ROUTINLY
FOR ABDOMEN AND
PELVIC VISCERAL INJURY
MRI OFFERS SIMILAR BENEFITES
OF CT ,WITH THE ADVANTAGES
OVER CT IN DELINEATING SOFT
TISSUE INJURIES,ABSENCE OF
IONIZING RADIATION,FRACTURES
OF CARTILAGINOUS STRACTURES
RADIOISOTOPE BONE SCAN
IS RARELY USEFUL FOR THE DIGNOSIS
OF NONDISPLACED PELVIC FRACTURES
AND IN THE IDENTIFICATION OF ACUTE
INJURIES IN CHILDREN ADULTS WITH
HEAD INJURIES OR MULTIPLE SYSTEM
INJURIES
Unstable pelvic fractures
1-2.5 cm pubis symphysis disruption
2-sacro spinous lig rapture
3-lateral sacral avulsion fx
4- ischial spine fx
5-sachral fx with gap(vertical
Instability )
6-L5 TRANSVERS PROCESS FX
(VERTICAL INSTABILITY )
7-VERTICAL DISPLACEMENT OF
HEMIPELVIS 1CM (VERTICAL)
8-STRES TESTING FOR INSTABILITY
ONLY ONE TIME HEMODINAMIC
INSTABILITY AND ZONE 2,3 SACRUM
DUE TO NERVE INJURY
STABLE Fx
1- intact posterior ligament
2-impact fx of anterior sacrum
)In LC fractures)