Pelvic fractures and associated injuries

Pelvic fractures are the third most frequent injuries in victims of motor vehicle accidents and are associated with abdominal injuries. The overall mortality has been reported to be greater than 15 per cent, rising to 50 per cent in patients with open pelvic fractures; hemorrhage remains the principal cause of death. Since pelvic fractures are often combined with other injuries and significant non-obvious bleeding, patients with severe pelvic fractures should initially be treated in the ICU. A cystogram should also be considered to rule out bladder perforation. Therapy depends on the presence of an open pelvic fracture, whether a stable or unstable fracture pattern exists, or whether there is a hemodynamic instability. Early external or internal reduction and fixation of many types of pelvic fractures may be necessary for mobilization of the patient. Major pelvic fracture bleeding is usually venous and can be managed by angiographic embolization. External fixation and application of military antishock trousers (MAST) can be helpful in control of bleeding from the pelvic venous plexus. Patients who do not respond to non-operative measurements must be taken to the operation room for laparotomy.

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