Trauma Guideline Manual - SUNY Upstate Medical University

Trauma Guideline Manual______________Upstate Medical University Trauma Center93PRACTICE GUIDELINES: PELVIC FRACTURESOBJECTIVES:1. Prevent and treat life-threatening hemorrhage.2. Establish early pelvic stability to decrease pain and allow an upright chest posture in orderto minimize pulmonary complications.3. Diagnose and manage concomitant urologic injuries.DEFINITIONS:Instability: An unstable pelvis ring disruption may be rotationally or rotationally and verticallyunstable.Open fracture: Implies a soft tissue injury allowing potential contamination of the fracture andmarkedly increased mortality rate (30-40%). Types of soft tissue injuries include perineallacerations, vaginal tears and rectal tears.CLASSIFICATION:Type A – stable:A1 Fractures not involving ring; avulsion injuries.A2 Stable, minimal displacement; iliac wing, isolated rami.A3 Transverse fracture of sacrumType B – rotationally unstable, but vertically and posteriorly stable:B1 External rotation instability; open-book injury.B2 Internal rotation instability; lateral compression injury.B3 Bilateral rotationally unstable injury.Type C – rotationally, posteriorly and vertically unstable:C1 Unilateral injury: ileal fracture, S1 disruption, sacral fracture.C2 Bilateral injury: one side rotationally unstable, one side vertically unstable.C3 Bilateral injury: both sides completely unstable.GUIDELINES:1. Follow the ABC’s; pay close attention to shock and resuscitation.2. Examine and document distal neurovascular status of limbs.3. Examine for urethral blood or scrotal hematoma.a. If present, obtain urethrogram prior to Foley.b. If hematuria present, obtain cystogram.4. Examine for perineal, vaginal or rectal lacerations.5. Avoid excessive movement and transfers. Every time the fracture moves, there is moreblood loss.6. Obtain pelvic X-ray/ CTScan.a. If obvious fracture, consult orthopedics.