Pelvic Trauma

Pelvic fractures are a major concern to the trauma team because they are often associated with other injuries including traumatic brain injury, abdominal injuries, thoracic injuries, and associated musculoskeletal injuries. High energy pelvic fractures have an associated 15-25% mortality rate, have an increased incidence of aortic rupture of eight times normal, and 60-80% have associated musculoskeletal injuries.1 Associated injuries directly related to pelvic fractures include:

• Hemorrhage: Can occur in up to 75% of high-energy pelvic fractures. Bleeding is most commonly from the pelvic venous plexus but can also be due to named arterial injury (internal, external iliac arteries and their branches).1 The retroperitoneal space can contain up to 4 L of blood from these sources.

• Visceral rupture: due to bony spicules or direct pressure from injury rupturing urethra, bladder, uterus, vagina, or rectum. Urogenital injury is seen in 12% of high-energy pelvic fractures.1 Rectal and vaginal exams must be performed to rule out any occult open fracture due to bony spi-cules associated with pelvic fractures.

• Neural disruption: the lumbosacral trunk and the L5 nerve root are especially vulnerable with sacral ala fractures and sacroiliac joint dislocations. The lumbosacral trunk is injured in 8% of high-energy pelvic fractures.1

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