First of all, our tremendous thanks to Chris Scheumann for coming in and helping us with this episode. For those of you who don’t know Chris, he is is possibly one of the most down to earth and approachable guys we have had the chance to get to know over the last year with this podcast. He is the Trauma Outreach Coordinator at Parkview Regional Medical Center in Fort Wayne, IN, and has been involved in EMS since the early 90s. I don’t know many people regionally that haven’t been affected by him in some capacity or another. Thanks, Chris, for being a true local resuscitationist.
Today, we are going to be talking about pelvic trauma. I know what many people’s reactions to this topic are. Groan. Pelvic trauma isn’t portrayed as a sexy injury type, but it is commonly one of the most missed by prehospital providers and emergency departments, and can have fatal consequences. So let’s get to it.
TYPES OF PELVIC FRACTURES
- Lateral compression fractures
- Pedestrian vs Car MVCs
- T-Bone MVCs
- Anteroposterior compression fractures
- Head-on MVCs
- Crush injuries
- Vertical shear fractures
- High falls
- DO NOT rock the pelvis
- DO NOT apply posterior pressure
- Attempt to assess with medial pressure
- Once you feel instability, DON’T LET GO
- This is not a type of injury you want the student to assess
- Shortening and rotation of lower extremity does not JUST indicate a hip fracture, but could show some degree of pelvic instability
- Remember that the pelvic girdle can hold upwards of 1.5L of blood; pelvic fracture can exanguinate into the retroperitoneal space as well.
WHY DO WE SPLINT THE PELVIS?
- Decreases amount of volume pelvis can hold
- Reduces instability of the broken pelvis
- Pain reduction by limited mobility of pelvis
- Contrary to popular belief, splinting alone does not tamponade pelvic bleeding
METHODS OF SPLINTING
- Draw sheet
- For the veterans in the field, MAST pants
- Commercial devices:
- Or the pelvic burrito wrap
- Disclaimer: There is posterior pressure applied during the assessment phase of the video; DO NOT USE POSTERIOR PRESSURE
- Pizanis, et. al. Injury. 2013 – Retrospective registry review of 207 pelvic bindings w/ c-
clamps, commercial binders & sheets. 31/207 used sheets. Increased lethal bleeding with
- Prasarn, et. al. J Trauma. 2012 – Study of 5 human cadavers. No difference in stability
between external fixation & TPOD.
- Prasarn, et. al. Injury. 2013 – Study of 5 human cadavers. Circumferential sheet equally as
effective as TPOD.
- Toth, et. al. Injury. 2012. Single center, retrospective review of 115 Type B & C pelvic
ring fx’s. Although deformity increased with lateral compression fractures patterns, no
worse outcomes were found.
- Cullinane, et. al. (inc. Matt Vassey). J Trauma. 2011. EAST Guideline. Systematic review of
literature on managing hemorrhage in pelvic fractures. Binding decreases pelvic volume &
reduces fracture displacement, but does not limit pelvic blood loss.
- Cullinane, D.C., Schiller, H.J., Zielinski, M.D., Bilaniuk, J.W., Collier, B.R., Como, J., Holevar, M. et. al. 2011. Eastern Association for the Surgery of Trauma Practice Management Guidelines for Hemorrhage in Pelvic Fracture – Update and Systematic Review. The Journal of Trauma, 71, 1850 – 1868.
- Toth, L., King, K.L., McGrath, B., & Balogh, Z. 2012. Efficacy and safety of emergency non-invasive pelvic ring stabilisation. Injury. 43, 1330 – 1334.