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Pelvic Ring Fractures
Posted: Dec 2 2020 #(C101647)
A

Pelvic Ring Injury in 18F

HPI

An 18-year-old female presents to the trauma bay after a MVC. She was intubated upon arrival and taken to the OR emergently for exploratory laparotomy, suprapubic catheter placement, and vaginal wall repair. Patient was noted to be a young, active, healthy patient.

PMH

Non contributory

PE

Patient was intubated and sedated on initial exam. Upon exam in the OR, she had active bleeding from vagina. No open wounds elsewhere. Vascular exam was unremarkable. Unable to perform nerve exam initially, but was completely neuro intact following traction pin placement and awakening from anesthesia. No obvious deformity on any of the extremities.

Poll
1 of 8
1. In addition to plain film radiographs, would you obtain any further imaging to guide your treatment?
No - current radiographs are sufficient
11%
124/1046
Yes - additional radiographs (i.e traction views)
3%
37/1046
Yes - CT pelvis (CT)
60%
629/1046
Yes - MRI pelvis (MRI)
1%
13/1046
Yes - XR + CT
15%
157/1046
Yes - XR + MRI
0%
4/1046
Yes - CT + MRI
3%
36/1046
Yes - XR + CT + MR
2%
23/1046
Outside my area of expertise - best if I don't vote
2%
23/1046
2. How would you classify this pelvic ring injury?
I would not use a classification system
2%
22/1054
LC1
0%
8/1054
LC2
3%
41/1054
LC3
14%
156/1054
APC1
0%
9/1054
APC2
2%
30/1054
APC3
3%
39/1054
Vertical Shear
35%
377/1054
Combined mechanism
29%
315/1054
Other
0%
4/1054
Outside my area of expertise - best if I don't vote
5%
53/1054
3. How would you manage this injury?
Nonoperative
1%
10/998
Operative
97%
969/998
Outside my area of expertise
1%
19/998
4. If you choose Operative management, what injuries would you address?
I would not choose Operative management
0%
1/981
Anterior pelvic ring only
1%
14/981
Posterior pelvic ring only
2%
20/981
Anterior pelvic ring FIRST, then posterior pelvic ring
33%
333/981
Posterior pelvic FIRST first, then anterior pelvic ring
55%
548/981
Outside my area of expertise
6%
65/981
5. If you choose Operative management, what approach would you use to manage the pelvic ring injury of the left hemipelvis?
I would not choose Operative management
0%
2/893
Percutaneous only
26%
237/893
Ilioinguinal
5%
49/893
Anterior intrapelvic only
3%
30/893
Anterior intrapelvic + Lateral window
15%
136/893
Lateral window only
1%
14/893
Posterior approach to the sacrum
7%
69/893
Posterior approach to the sacrum + Anterior intrapelvic
27%
242/893
Other
2%
19/893
Outside my area of expertise
10%
95/893
6. If you choose Operative management, what would be your definitive fixation of the POSTERIOR pelvic ring injury?
I would not choose Operative management
0%
0/860
Screws only
57%
491/860
Anterior SI plate
3%
30/860
Posterior SI plate
3%
30/860
Anterior SI plate + screws
11%
103/860
Posterior SI plate + screws
16%
143/860
Outside my area of expertise - best if I don't vote
7%
63/860
7. If you choose Operative management, what would be your definitive fixation of the ANTERIOR pelvic ring injury?
I would not choose Operative management
0%
1/829
I would not provide any anterior fixation after posterior fixation
1%
9/829
External fixation only
8%
71/829
Infix Device only
2%
21/829
Percutaneous screws only
4%
38/829
Open reduction and plate fixation
69%
574/829
Combination of above
8%
70/829
Outside my area of expertise
5%
45/829
8. If you choose Operative management and attained the construct shown below, what weight-bearing status would you assign the patient?
I would not choose Operative management
0%
1/679
WBAT BLE
4%
29/679
NWB BLE
34%
235/679
NWB RLE, WBAT LLE
10%
70/679
NWB RLE, TDWB/PWB LLE
10%
73/679
WBAT RLE, NWB LLE
15%
103/679
TDWB/PWB RLE, NWB LLE
11%
75/679
Other
3%
21/679
Outside my area of expertise
10%
72/679
PROCEDURE #1 DOP: 12/1/2020

Skeletal traction placement following exploratory laparotomy, vaginal wall repair, and suprapubic catheter placement

PROCEDURE #2 DOP: 12/2/2020

Open reduction internal fixation of left pelvic ring injury, percutaneous screw fixation of right anterior column acetabulum, and placement of anterior external fixator

Intra-procedure P2
icon
OUTCOMES
Post-procedure P1
Post-procedure P2
7 months after
Post-procedure P2
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