Surgery - Pelvis

Clinical Findings Suggesting Pelvic Injury

Obvious deformity or an open injury may indicate significant pelvic trauma.

Localised pelvic pain or limb paraesthesia may suggest associated bony or neurological injury.

Signs of retroperitoneal haemorrhage include bruising of the scrotum, buttocks, or along the line of the inguinal ligament, known as Fox’s sign.

Signs of urethral injury include blood at the urethral meatus, a high-riding prostate, and an inability to void urine.

Rectal examination may reveal blood or palpable bony fragments.

Reduced anal tone may indicate associated neurological or lumbosacral injury.

Abnormal pelvic stability on clinical assessment may also suggest disruption of the pelvic ring.

Types of Pelvic Injury

External rotation of the hemipelvis occurs with disruption of the pubic symphysis and is typically associated with anteroposterior compression.

This injury pattern may be caused by a direct anteroposterior compression force.

It may also result from a direct posterior blow to the iliac spines.

Forced external rotation of the lower limb can also produce this pattern of pelvic injury.

Internal rotation of the hemipelvis is associated with compression fractures of the pubic rami and usually results from lateral compression.

This pattern is typically caused by a lateral impact producing medial compression of the pelvis.

Vertical shear injury involves fracture-dislocation of the hemipelvis with superior and posterior displacement.

It is caused by a vertical loading force that fractures the pubic rami and disrupts the sacroiliac joint, resulting in displacement of the affected hemipelvis.

Pelvic Springing

Pelvic springing is a clinical test used to assess the stability and integrity of the pelvic ring.

It involves gentle compression of the iliac wings.

The aim is to identify pelvic instability that may suggest a fracture before imaging is obtained.

Main Concern in Pelvic Fracture

The major concern in pelvic fracture is uncontrolled haemorrhage into the pelvic cavity.

The pelvis can accommodate several litres of blood, so significant haemorrhage may occur before it becomes externally apparent.

Interim Management of Unstable Pelvic Fractures

A sheet may be placed beneath the buttocks and wrapped anteriorly around the pelvis, with the ends secured to provide a basic temporary splint.

Anterior external fixation may be used by inserting two pins into the anterior border of the ilium on each side and connecting them with a rigid external frame.

Posterior external fixation may involve pin insertion along the line between the anterior superior iliac spine and posterior superior iliac spine, with the pins connected using a reduction clamp.

External fixation should be performed by an experienced orthopaedic surgeon because of the risk of iatrogenic neurovascular injury.