Open book pelvic fracture

Background

  • 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

Evaluation

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  • 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

References