5.9E Ortho Ll Fractures Pelvis Hip Foot Em

Front 1

Pelvic fractures true/false
1 degree of ligamentous disruption is a major determinant of bleeding
2 pelvis should be rocked to determine stability
3 an awake and alert pt without pelvic pain/tenderness highly unlikely to have pelvic fracture
4 with regard to lateral compression fractures hypotension is usually due to pelvic bleeding

Back 1

1 T, as is severity of fracture displacement; >2mm displacement anywhere = high risk
2 F - grab iliac crests and push in - opening the pelvis by rocking will cause further exsanguination
3 T
4 F - pelvic ligaments usually intact with this mechanism

Front 2

Young and Burgess classification of pelvic fractures is also known as the 'shock trauma' classification. 3 types. Lateral Compression, AP Compression and Vertical Shear. Regarding this classification
1 which type is most likely to result in significant bleeding?
2 which is least likely to bleed?
3 which may NOT involve a fracture?
4 which may disconnect the leg from the axis

Back 2

1 AP compression/open book
2 Lateral compression
3 AP compression (may be purely ligamentous)
4 Vertical shear - creates complete hemipelvis disruption

3 types
1 LATERAL COMPRESSION - usually fractured pubic rami +/- sacral compression fracture, bleeding not prominent as pelvis shortens/implodes
2 AP COMPRESSION - usually symphysis pubis opens and SI jt disruption occurs (unilateral), 'open book'. Bony component may be small or nil!! Bleeding prominent due to ligamentous damage. Pelvis explodes
3 VERTICAL SHEAR - due to fall from height, head on MBA. COMPLETE anterior (through rami) AND posterior (through SI jt) dislocation e.g complete hemipelvis disruption - legs no longer connected to axial skeleton.

Another axiom - stable pelvic fracture + hypotension - usually abdominal source. Unstable pelvic fracture + hypotension - source less predictable

Front 3

Regarding management of pelvic fractures which is incorrect
1 lower extremity neurological assessment is important
2 any pelvic fracture can caused significant haemorrhage, even LC fractures though usually in elderly
3 haemodynamically unstable pt should be presumed to have pelvic bleeding and go to angio suite
4 pelvic binder should be used for any haemodynamically or skeletally unstable fracture

Back 3

1 T - strong link b/n pelvic trauma and neurologic injury
2 T
3 INCORRECT - always consider other sources: Chest - CXR (ICC), long bone fractures, abdomen - FAST, +/- CT. If uncertain OT first may be most suitable as pelvis may be packed while evaluate abdomen first - 'if not sure, go to OT'

Front 4

Name the injuries that may complicate pelvic #

Back 4

Urethral - dx w retrograde urethrogram, contrast must be visualised in bladder on plain XR to be negative
Bladder rupture - dx w CT cystogram
Bowel
DiaphragmBrain
Long bone
Nerve
Aortic transection