Traumatic Pelvic Fractures: A Brief Report

Frenkel Nadya^*
*Correspondence: Frenkel Nadya, Department of Psychiatry, Mahidol University, Bangkoknoi, Thailand, Email:

Brief Report

The treatment of patients with traumatic pelvic fractures remains a substantial issue that necessitates a multidisciplinary team's prompt assessment and response. Motor vehicle collisions, people impacted by a vehicle, falls from great heights, and crush injuries are all examples of common injury mechanisms. The total mortality rate for all types of pelvic fractures ranges from 5% to 15%, with the risk of death rising dramatically in those who are haemodynamically unstable at the time of presentation. Mortality is further increased by advanced age, open pelvic fractures, and serious head, chest, or intra-abdominal damage. In these individuals, haemorrhage is the most common cause of death, but bleeding from other injuries is often a factor. Traumatic brain injuries are prevalent and account for about 20% of all early deaths. 3 Long-term consequences include physical and mental health issues, which result in a significantly lower quality of life for survivors and major socioeconomic consequences for society.

Patient resuscitation, fracture stabilisation, and definitive fixation are the top three priority in the treatment of high-energy pelvic fractures. The goal of this essay is to go over the anaesthetic management of these patients from the time they arrive at the hospital until the time they leave. It also discusses the pelvic floor's function, pertinent anatomy, and the classification of pelvic injuries.

The pelvis's functions

Because of its bowl-like form at the base of the axial skeleton, the term 'pelvis' is derived from the Latin word for'basin.' Many essential structures run through it as it connects the upper body and lower limbs. The pelvis has several purposes, including: I weight transmission from the axial skeleton to the lower appendicular skeleton; (ii) attachment point for numerous muscles and ligaments that aid in locomotion and balance; and (iii) protection of the reproductive, bladder, and small intestinal organs.

The innominate bones, the sacrum, and the coccyx make up the skeletal pelvis. Individual bones make up the big innominate bone, which by adulthood have fused to create the acetabulum. The ilium is the largest of the three bones, and it creates the innominate bone's superior appearance. The ischium is divided into three sections: superior ramus, body, and inferior ramus, and it makes up the posterior-inferior region of the innominate bone. The pubis, which is separated into the body, superior ramus, and lower ramus, forms the front section of the innominate bone. The sacrum is a triangle bone that forms the posterior wall of the pelvis by fusing five sacral vertebrae together.

The ring around the pelvis

It's helpful to think of the pelvis as a ring-like structure formed by the sacrum and the paired innominate bones while examining the damage process. This ring's stability is determined by the ligamentous structure that surrounds it. The interosseous sacroiliac ligament is the most powerful of a network of stabilising muscles and ligaments that limit the sacroiliac joint's mobility. The posterior sacroiliac ligaments are far more powerful than the anterior sacroiliac ligaments, which are more easily torn. The pubic symphysis is reinforced by a number of ligaments, yet it remains the weakest part of the pelvic ring. Pelvic ring injuries are classified as either stable or unstable.

Stable defects are caused by a low-energy source of injury and heal quickly. Unstable injuries are classified as either having simply rotational instability or having both rotational and vertical instability. They typically occur as a result of a high-impact injury and are more commonly connected with bleeding. Rotational instability permits the pelvis to spread (like a book), increasing volume and decreasing tamponade ability. Vertical instability permits the hemipelvis to translate vertically, causing widespread soft tissue damage and serious haemorrhage. Unless the ambulance team diverts to the nearest hospital due to cardiac arrest on presentation or in route, the majority of pelvic fractures present to major trauma centres. To help diagnose and manage lifethreatening injuries, advanced trauma life support techniques should be used at once. With suspected pelvic fractures, many prehospital retrieval techniques include the use of a pelvic binder. When vertical instability is apparent, the correct administration of the pelvic binder should be checked, and skeletal traction should be performed. Pelvic fractures are rarely iso- lated injuries, thus the severity of the injuries may affect how they are treated.

The mechanism of damage, clinical examination, and radiological data should all be used to define pelvic injury in the setting of significant trauma. Mechanical stress on the pelvis should be avoided to avoid destabilising clot development. In the beginning, log rolling should be avoided, and straight lifts are preferred. The patient's haemodynamic situation will determine which radiological examinations should be performed. If the patient responds to first resuscitation, a CT scan should be performed. If the patient refuses to respond to resuscitation, quick action is essential to avoid death. All specialties engaged in the patient's treatment should be consulted before making decisions. An AP radiograph of the pelvis can assist lead the diagnosis before transport to theatre, and bedside ultrasonography may help rule out additional causes of shock such as tension pneumo-thorax and pericardial tamponade. Angiography and embolisation, which can be done quickly if the facility is available or pelvic packing after an emergency laparotomy are two alternatives for rapid treatment. Traumatic pelvic fractures have such a high mortality rate, so strong communication among the multidisciplinary team is critical to ensuring the highest chance of survival. Initial therapy focuses on patient resuscitation and haemorrhage arrest using the modalities available in the area, followed by early definitive fixation. This approach has been improved by the growth of trauma systems and technological breakthroughs in imaging, embolization techniques, and minimally invasive surgery. Chronic pain and deteriorated physical and mental health are long-term consequences of pelvic trauma, and enhancing survivors' quality of life continues to be an issue [1-6].

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