Open book pelvic fracture with diastasis of the symphasis pubis and sacro-iliac joint. Dislocation of the left femur.

Considerable force is required to cause a pelvic fracture and there is a high association with injury to distant organs - brain injury, liver laceration, aortic disruption.

Complications of pelvic fractures

■ Haemorrhage: can be life threatening.

■ Bladder injury: consider cystogram.

■ Urethral injury: consider urethrogram (prior to bladder catheter insertion).

■ Prostate injury.

■ Rectal and perineal injury.

■ Neurological injury.

■ Sepsis from bowel or urinary tract injury.

The pelvis is supplied by an extensive venous plexus and several major arteries. Initial managagement of a major pelvic disruption associated with haemorrhage requires haemorrhage control and rapid fluid resuscitation. Simple techniques such as wrapping the 'open book' pelvic injury in a 154 sheet to try to stabilise the pelvic ring can temporarily improve

Fig. 3.34 Angiogram in patient with pelvic fracture demonstrating active bleeding. This was subsequently coiled.
Fig. 3.35 Contrast enhanced CT scan. Note the right-sided pelvic fractures and the contrast extravasation from active bleeding.

haemostasis but control of haemodynamically unstable patients needs urgent surgery or angiography (Fig. 3.34). Pelvic surgery may decompress tamponaded retro-peritoneal haematoma and for this reason angiography may be preferred. Certain anatomical locations predispose to vessel injury (Fig. 3.35). Injuries of the sciatic notch, crush injuries of the sacrum and vertical shear injuries can all result in arterial tears.

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