CASE ATLS principles in the workup and management of a pelvis fracture 21

 

A 30-year-old male presents to your local trauma center following a motor vehicle

collision. On arrival to the trauma bay his vital signs reveal a pulse of 127 with a manual blood pressure that is within normal limits. On your initial assessment you do not appreciate any gross deformity or open wounds to the extremities. The trauma team proceeds with the ATLS protocol.

All of the following radiographic views are recommended in the ATLS protocol for evaluation of the acutely traumatized patient EXCEPT:

1. Anteroposterior pelvic view

2. Lateral cervical spine view

3. Anteroposterior chest view

4. Single anteroposterior view of any perceived long bone deformity

 

Discussion

The correct answer is (D). After completion of the primary survey and AP chest, AP pelvis, and lateral C-spine, film are considered the most useful radiographic adjuncts at this very early stage of the trauma survey. Even in the setting of gross extremity deformity these three images remain the essential radiographic views to obtain.

The primary and secondary surveys are completed, and the patient is now tachycardic to the 140s with otherwise stable vitals. His pelvic examination is limited by his morbid obesity, however you note ecchymosis over the anterior abdomen and concomitant scrotal edema. His AP pelvis is shown in Figure 6–28.

 

 

 

Figure 6–28

 

What is the next most appropriate step?

1. Obtain CT scan to classify extent of pelvic ring injury

2. Place pelvic binder after ruling out nonpelvic etiologies for the patients with tachycardia

3. Place pelvic binder centered over the iliac wings without delay

4. Place pelvic binder centered over the greater trochanters without delay

 

Discussion

The correct answer is (D). The patient remains tachycardic following the primary and secondary ATLS surveys. Furthermore, he displays cutaneous stigmata of a pelvic ring injury on examination with concomitant anterior diastasis of the pubic symphysis. The next most appropriate step as the consulting orthopedists will be appropriate placement of a pelvic binder, centered over the greater trochanters, prior to transfer for advanced imaging.

Which of the following is the most common associated injury with fractures of the pelvic ring?

1. Long bone fractures

2. Chest injuries

3. Abdominal injuries (liver, spleen, bladder, and urethral trauma)

4. Spine fractures

 

Discussion

The correct answer is (B). Chest injuries are present in up to 63% of patients who presents with pelvic fractures. Long bone fractures, abdominal injuries, and spine fractures are also commonly found in these multiply injured patients (50%, 40%, and 25%, respectively).

 

Objectives: Did you learn...?

 

 

ATLS principles in the workup and management of a pelvis fracture? Injuries commonly associated with pelvic fractures?