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Extra info for Fractures of the Pelvis and Acetabulum
9 showing a right sacral fracture, right lung contusion with hematothorax and free fluid at the spleen. Ga¨nsslen et al. 38 Figure 9 In suspected urological lesions, a retrograde urethrogram is performed, in this case showing an extraperitoneal bladder laceration. For emergency classification of these injuries and to facilitate the identification of life-threatening pelvic injuries, the following definitions have been shown to be useful, practicable, and of relevance as far as a prediction of mortality is concerned (34) (Table 1): .
They are most commonly caused by a low-energy trauma. The subgroups are defined as: Type A1: Rim avulsion fractures of the iliac spine or tuberosity Type A2: Stable iliac wing fractures or minimally displaced fractures of the pelvic ring Type A3: Inferior transverse fractures of the sacrum or coccyx Rotationally unstable injuries of the B type (Fig. 3) are characterized by a complete anterior pelvic ring disruption in conjunction with an incomplete disruption of the posterior elements. This leads to partial instability with respect to rotation, while vertical stability is maintained.
11). Clinically, these cases often present as abdominal injuries. As the retroperitoneum is not a closed space, pressure induced tamponade is not of clinical importance (60). Acute Management of Pelvic Fractures: A European Perspective Table 2 41 Treatment Options in Patients with Pelvic and Hemodynamic Instability Type of treatment Advantage Disadvantage Self tamponade None MAST Direct compression of the pelvic ring and the lower extremities None Only in hemodynamic stable patients valid Disruption of all compartimental borders Access to the traumatised region is limited Possible hazardous complications Collateral supply None Unknown Possible Arterial bleeding source in only 10% to 20% Time consuming Possible Only temporary measure Patient access impaired Critical in C-type injuries Yes Yes Time consuming Yes Special indications Knowledge of anatomy Possible complications Time consuming Special indications Yes Ligation hypogastric artery Pelvic sling/belt Angiography/ embolization Temporary aortic occlusion External fixation Direct bleeding control C-clamp Internal fixation Direct pelvic compression without access limitations Biomechanical effective Open access to retroperitoneal space unnecessary Isolated arterial bleedings may be controlled without surgical intervention Acute effectivity Easy and fast handling Control of blood loss by direct pressure on bleeding vessels or prevention of repeated insults to already clotted vessels Control of major vascular injuries Posterior pelvic stabilization Basis for tamponade Biomechanical most effective Effectivity None None Yes Abbreviation: MAST, military antishock trousers.