OR2.7 | Pelvi-acetabular Injury with Hemodynamic Instability — Summary & Reflection

KEY TAKEAWAYS

Pelvic ring and acetabular fractures result from high-energy trauma and are classified by the Young-Burgess (mechanism-based: LC/APC/VS/CM) and Tile (stability-based: A/B/C) systems. Haemodynamic instability arises primarily from disruption of the presacral venous plexus and internal iliac branches, with the retroperitoneal space accommodating massive blood loss before tamponade fails. Emergency management follows ATLS principles with simultaneous MTP activation, pelvic binder application at the greater trochanters, and damage-control resuscitation. The haemostasis decision tree distinguishes arterial bleeds (CT blush → angioembolisation) from venous/bone haemorrhage (PPP + external fixation). Emergency antibiotics within 1 hour are mandatory for open pelvic fractures. Definitive fixation — anterior plating, percutaneous SI screws, or ORIF — is delayed until physiological restoration. Acetabular fractures displaced >2 mm or mechanically unstable require ORIF; post-traumatic osteoarthritis is the long-term sequela. Neurological injury, bladder/urethral injury, and Morel-Lavallée lesions are important associated injuries requiring systematic assessment.

REFLECT

You are the first doctor assessing a 45-year-old woman who fell from a second-floor window and arrives with BP 85/60 mmHg after 1 L saline. The pelvic X-ray shows a Type C (Tile) pelvic fracture. The FAST is negative. The ED nurse asks if she should insert a urinary catheter because the patient cannot void. Reflect on: (1) What is your priority in the next 2 minutes? (2) Should a urethral catheter be inserted, and if not, why not? (3) How does a negative FAST change your management? (4) What is the conversation you need to have with the trauma team leader and the interventional radiologist?