View source for Open book pelvic fracture

==Background==
[[File:Skeletal pelvis-pubis.png|thumb|The skeleton of the human pelvis: 1. Sacrum; 2. Ilium; 3. Ischium; 4. Pubic bone (4a. corpus, 4b. ramus superior, 4c. ramus inferior, 4d. tuberculum pubicum); 5. Pubic symphysis, 6. Acetabulum (of the hip joint), 7. Foramen obturatum, 8. Coccyx/tailbone; Dotted. Linea terminalis of the pelvic brim.]]
[[File:Slide12DEN.jpg|thumb|Pelvis anatomy, medial view.]]
[[File:Slide14DEN.jpg|thumb|Pelvis anatomy, lateral view.]]
*Results from an anteroposterior compression injury to the pelvis
*Often seen in elderly falls vs MVA or other high speed trauma
*Causes disruption of pubic symphysis and the pelvis opens like a book
*Results in tears of the strong pelvic ligaments that hold the pelvis bones together
*Large arteries pass near these ligaments and can get torn resulting in massive blood loss

==Clinical Features==
*pelvic/Hip pain
*Unstable pelvis
*hypotension if large amounts of bleed
*Consider concomitant GU injury

==Differential Diagnosis==
{{Abdominal trauma DDX}}

==Evaluation==
[[File:Picture4.jpg|thumb|]]
*Unstable pelvis on exam
*Xr pelvis in acute trauma setting
*CT Pelvis 

==Management==
*Stabilize fracture with pelvic binder or bed sheet wrapped around greater trochanter (physician's often make mistake of wrapping around the iliac crest)
*If suspect pelvic injury and patient is unstable, place pelvic binder/sheet immediately then obtain X-ray when patient is stable
**If patient persistently hypotensive even after binder and suspect pelvic artery bleed consider IR for embolization
*Long term management requires orthopedic consultation

==Complications==
*[[Hypotension]] from exsanguination 
*infection
*Loss of function
*Genitourinary injury

==Disposition==
Admission

==See Also==
*[[Pelvic fractures]]

==References==
<references/>
[[Category:Orthopedics]]