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A 37-year-old male is struck by a car while walking at night. He is hemodynamically unstable at initial evaluation in the trauma bay. Advanced Trauma Life Support protocols are started, and an initial survey is completed. A chest radiograph and a pelvis AP radiograph (Figure A) are obtained. What is the most appropriate next step?
The patient should be taken directly to the OR for percutaneous placement of a pelvic external fixator
Dedicated inlet and outlet views of the pelvis to better classify the fracture
Continued resuscitation and immediate CT of the chest, abdomen and plevis
Emergent trip to interventional radiology for pelvic embolization
Immediate application of pelvic binder, continued resuscitation and re-evaluation of hemodynamic status
Select Answer to see Preferred Response
A 65-year-old female presents with the injury seen in Figures A and B after a motor vehicle collision. She is hemodynamically unstable and undergoes emergent pelvic supra-acetabular external fixation followed by laparotomy. She is now hemodynamically stable and cleared for surgery. She has no evidence of neurologic deficit on examination. Which of the following factors is a relative contraindication to open reduction and plating of her posterior pelvic injury from an anterior approach?
Supra-acetabular external fixtator
Ipsilateral proximal femur fracture
A 25-year-old male is involved in a motor vehicle accident and sustains the injury seen in Figure A. He is intubated in the field and receives 2 liters of LR and continues to be tachycardic and hypotensive. A massive transfusion protocol is initiated. Which of the following is true regarding the transfusion of packed red blood cells, platelets, and fresh frozen plasma?
PRBC should be transfused until Hgb>8
PRBC, platelets, and FFP should be transfused in equal ratios
Platelets and fresh frozen plasma should be given when INR >1.4, platelet count <100,000
FFP is not needed unless INR>1.5
Platelets should not be transfused unless platelet count <10,000
A 72-year-old woman falls down the stairs and is now unable to bear weight secondary to right groin pain. Injury radiograph and CT scans are seen in Figures A through C. What is the Young-Burgess classification of this injury and the most appropriate treatment plan?
Bilateral weight bearing as tolerated for Anterior Posterior Compression Type I injury
Touchdown weight bearing on the right for Lateral Compression Type I injury
Bilateral weight bearing as tolerated for Lateral Compression Type I injury
Posterior sacroiliac screw, followed by non-weight bearing for Lateral Compression Type II injury
Posterior sacral plate, followed by non-weight bearing for Lateral Compression Type III injury
A 24-year-old male sustains the injury seen in Figure A after being thrown from a motorcycle at a high speed. Which of the following fixation methods has been shown to be the most stable fixation construct for this injury?
Posterior bridge plating and anterior ring external fixation
Percutaneous iliosacral screw and anterior ring external fixation
Percutaneous iliosacral screw and anterior ring internal fixation
Two percutaneous iliosacral screws
Risk of postoperative fixation failure for a complete sacral fracture has been associated with what variable?
Anterior pelvic ring fixation method
Vertical nature of sacral fracture
Iliosacral screw length
Number of iliosacral screws
Age > 50
Which of the following is an appropriate initial step in the management of a multiply injured patient with an unstable pelvic ring fracture and hemodynamic instability?
Application of an external fixator
Application of a pelvic binder
Percutaneous Iliosacral screws
A 34-year-old female presents to the trauma bay with hemodynamic instability following a motor vehicle collision. A chest radiograph shows a left-sided hemothorax and her pelvis radiograph is shown in Figure A. Which of the following is the next most appropriate step in managment?
Circumferential pelvic sheeting
Retrograde urethrogram to evaluate for associated urologic injury
Emergent transport to OR for pelvic anterior external fixator placement
CT scan to assess for occult femoral neck fracture
Bedside posterior pelvic C-clamp application
What structure has been described as having a risk of injury with retractor placement on the sacrum during combined acetabular-pelvic ring surgery using the Stoppa approach with a lateral window?
External iliac artery
L5 nerve root
Based on the Young and Burgess classification of pelvic ring injuries, an anterior-posterior compression type II injury does not result in disruption of which of the following?
anterior sacroiliac ligaments
posterior sacroiliac ligaments
A 41-year-old woman is brought to the emergency department after she was the unrestrained driver in a rollover motor vehicle accident. She was placed in a cervical collar and intubated at the scene. Her blood pressure is 80/40 and pulse is 140. She has obvious open fractures of the right forearm and left ankle. On exam, the lower extremities are externally rotated and the pubic symphysis is widened and unstable. Intravenous access is obtained and radiographs are pending. What is the most urgent next step in management?
Lateral radiograph to clear the cervical spine
External fixator application to the left ankle in the operating room
External fixator application to the pelvis in the operating room
Pelvic binder application
Reduction and splinting of the right forearm
Alternating single-leg-stance radiographs are most helpful for evaluation of which of the following diagnoses?
Leg length discrepancy
Pelvic ring instability
Hip abductor weakness
A 7-year old boy presents to the emergency room following a ATV accident with complaints of left pelvic pain. In the emergency room he is alert and oriented and is hemodynamically stable. On physical exam he is unable to bear weight on his left lower extremity. There is no tenderness to palpation at the posterior pelvis. A radiograph is performed and shown in Figure A and CT examination shows the posterior ring is stable and age-appropriate. What is the most appropriate treatment for this injury pattern?
Nonoperative management with weight bearing as tolerated
Percutaneous sacroiliac screw
Pelvic external fixation
Anterior pelvic ring plating
Anterior and posterior pelvic ring plating
Of all the pelvic ring injury types, anteroposterior compression type III pelvic ring injuries have the highest rate of which of the following?
Need for transfusion
Upper extremity fractures
A 31-year-old male sustains an ipsilateral displaced transverse acetabular fracture, pubic rami fractures, and a sacroiliac joint dislocation. What structure should be reduced and stabilized first?
A 35-year-old male involved in a high-speed motor vehicle collision presents to the trauma bay hypotensive and with a clinically unstable pelvis. A pelvis radiograph is shown in Figure A. He is placed in a pelvic binder, and his blood pressure normalizes temporarily. An abdominal CT demonstrates free fluid and air in the intraperitoneal cavity, and a laparotomy is indicated. What is the most appropriate next step in orthopaedic management?
Percutaneous SI screw placement
External fixation placement
Pubic symphysis plating
Posterior pelvic plating
Anterior sacroiliac plating
During percutaneous iliosacral screw placement for an unstable pelvic ring injury, use of the lateral sacral fluoroscopic image is critical to help avoid iatrogenic injury to what structure?
L4 nerve root
S1 nerve root
Sacroiliac joint cartilage
For a patient with an unstable pelvic fracture, the amount of blood tranfusions required in the first 24 hours has shown to be most predictive for what variable?
Length of hospital stay
Association with neurological deficit(s)
Length of intensive care stay
A 27-year-old woman gives birth by normal spontaneous vaginal delivery. Two weeks after delivery she reports anterior pelvic pain and a radiograph is obtained (Figure A). What is the next step in management?
Pelvic external fixator
Open reduction and reconstruction plating of the symphysis
Protected weightbearing and binder as needed and observation
Open reduction and wiring of the symphysis
A 32-year-old male is involved in a motor vehicle collision and sustains the injury seen in Figure A. What is the most common urological injury associated with this injury pattern?
Posterior urethral tear
A 23-year-old male is an unrestrained driver in a motor vehicle accident and sustains an unstable pelvic ring fracture. During fluoroscopic-aided fixation, a lateral sacral view is used for proper placement of which of the following fixation methods?
Anterior column percutaneous screw placement
Posterior column percutaneous screw placement
Posterior iliosacral plating
Supra-acetabular pin placement
Percutaneous iliosacral screw placement
A 23-year-old male is involved in a motor vehicle accident and sustains a left open femur fracture, right open humeral shaft fracture, and an LC-II pelvic ring injury. Which of the following best describes the radiographic findings associated with this pelvic injury pattern using the Young-Burgess Classification system?
Crescent fracture located on the side of impact
Widened anterior SI joint, disrupted sacrotuberous and sacrospinous ligaments with intact posterior SI ligaments
Complete SI disruption with lateral displacement
Sacral compression fracture on side of impact with transverse pubic rami fractures
Open-book injury with contralateral sacral compression fracture
Which of the following descriptions is true regarding APC-II (anterior-posterior compression) pelvic injuries as classified by Young and Burgess?
Pubic symphysis diastasis, intact anterior sacroiliac ligaments, intact sacrotuberous ligament, intact posterior sacroiliac ligaments
Pubic symphysis diastasis, torn anterior sacroiliac ligaments, intact sacrotuberous ligament intact posterior sacroiliac ligaments
Pubic symphysis diastasis, intact anterior sacroiliac ligaments, torn sacrotuberous ligament, intact posterior sacroiliac ligaments
Pubic symphysis diastasis, torn anterior sacroiliac ligaments, torn sacrotuberous ligament, intact posterior sacroiliac ligaments
Pubic symphysis diastasis, intact anterior sacroiliac ligaments, torn sacrotuberous ligament, torn posterior sacroiliac ligaments
A 32-year-old male sustains an APC-III pelvic ring disruption after a motor vehicle collision. Which of the following imaging techniques best describes the correct utilization of intraoperative flouroscopy for percutaneous iliosacral screw placement across S1?
Inlet view helps best guide superior-inferior orientation
AP pelvis best guides anterior-posterior screw orientation
AP pelvis best guides superior-inferior screw orientation
Outlet view best guides anterior-posterior screw orientation
Outlet view best guides superior-inferior screw orientation
What risk factor leads to the highest rate of postoperative loss of reduction in unstable posterior pelvic ring injuries?
Type of anterior fixation
Usage of a transiliac bar
Vertical sacral fracture
Sacroiliac joint fracture-dislocation
A 23-year-old female is an unrestrained driver in a motor vehicle collision, sustaining the injury shown in Figure A. She subsequently undergoes reduction and percutaneous bilateral iliosacral screw placement. Which of the following is the most likely neurologic complication associated with percutaneous iliosacral screw insertion?
Weakness in knee extension
Decreased patellar reflex
Weakness in great toe extension
Weakness in ankle plantar flexion
Decreased Achilles reflex
A 40-year-old male laborer sustained a fall from height and has isolated pelvic pain. He is otherwise hemodynamically stable. A radiograph is shown in Figure A. A stress examination under anesthesia does not show any further anterior diastasis or posterior pelvic ring displacement. Computed tomography reveals no asymmetry of the sacroiliac joints. What is the most appropriate management of this injury?
protected weight-bearing and pain control
open reduction and internal fixation
skeletal traction followed by open reduction and internal fixation
pelvic external fixation
pelvic external fixation followed by sacroiliac screws
What nerve is most at risk when applying the external fixator shown in Figure A using a minimally invasive fluoroscopic technique of pin insertion?
First branch of the femoral nerve
Lateral femoral cutaneous nerve
Superior gluteal nerve