Hemodynamically unstable pelvic fractures are a talk-and-die situation. These folks require aggressive, rapid treatment if they are going to survive the injury. Inspired by my mentor, Thomas Scalea, I discuss the management of the unstable pelvic trauma patient.

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Part I

Part II

Young-Burgess Shock Trauma Pelvic Fracture Classification

(J Trauma 30(7): 848-856)

from the handbook of fractures

Open Iliac Artery Clamping

Dubose and Inaba (J Trauma. 2010;69: 1507?1514)How to Kill when IntubatingForgot to mention on the podcast--The combination of an open-book pelvis that you have not bound yet and paralytics is a great way to cause massive bleeding. Bind the open pelvis before tubing!!!

New East Pelvic Trauma Guidelines

(J Trauma 2011;71(6):1850)

* external fixation doesn’t limit blood loss, but reduces fracture displacement (III)

* unstable patients should get angio (I)

* pts with blush may require angio even if stable (I)

* ongoing bleeding after angio should get repeat angio (II)

* >60 y/o with major fx should get angio even if stable (II)

* anterior fxs assoc with ant vessel injury and posterior = posterior (III)

* Bilateral non-selective is safe, gluteal ischemia is more likely from injury not angio (III)

* And doesn’t affect male potency (III)

* FAST is insensitive in pelvic trauma (I)–don’t agree with this one

* Adequate Specificity (I)

* DPA is test of choice (II)

* Use CT if stable (II)

* Fracture pattern doesn’t predict need for angio (II)

* Nor hematoma location (II)

* Absence of ICE doesn’t exclude active hemorrhage (II)

* Volume > 500 cm3 predicts need for angio (III)

* Isolated acetabular fx may still need angio (III)

* Perform cystogram after ct (III)

* Binders reduce fx as well as definitive stabilization and decrease pelvic volume (III)

* And they limit hemorrhage (III)

* They work as well or better than external fixation in controlling hemorrhage (III)

* RetroP Packing can be used to salvage after failed angio (III)

* Can be used as primary in an integrated protocol (III)