Karnataka PGET Orthopedics MCQ Answer 3

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The Correct Answer is C

The vast majority of pelvic fractures are closed fractures, and are not contaminated by exposure to the external environment. The initial management in pelvic fracture cases is therefore geared towards patient stabilization and evaluation of internal injuries. With the exception of acetabular fractures, there is no hurry to fix the fracture before the patient is fully stabilized. Of particular importance is evaluation of the urogenital tract, and of the respiratory tract.

The key is stability, not just of the fracture but more importantly of the patient! Depending on the circumstances, hemodynamic instability can occur in any patient with a pelvic injury!

Epidemiology

  • Overall mortality rate – 6-8%
  • AP compression – higher incidence of retroperitoneal hemorrhage (than intra-abdominal)
  • Lateral compression and Vertical shear – higher incidence of intra-abdominal and head injuries
  • Deaths:
      • 39% from pelvic hemorrhage
      • 31% from head injury
      • 30% from multiple organ failure

Pelvic Fracture Management
  • PHASES:
  • resuscitation
  • provisional stabilization (temporization)
  • definitive stabilization

Adequate Resuscitation

  • warm the Patient!
  • early transfusion (warm -> type specific > O-ve)
  • clotting (FFP/plts -> ‘5/1 rule’ / plts less than 50 lacs/cmm)
  • ongoing assessment:
    • BP, HR, u/o
    • Base Deficit
    • Lactate
    • invasive monitoring (CVP, S-G)
Hemodynamic Instability
  • SBP less than 90mm Hg
  • Unresponsive to fluids/blood
  • Mortality:
    • Shock on admission associated with pelvic fracture is the most reliable predictor of ISS, transfusion requirement and death (40%)

Management of Shock

  • ATLS - identify the source
    • Establish and follow protocols
    • Coordinated team approach to patient care
  • Temporary pelvic volume reduction
  • Acute pelvic external fixation +/- traction
  • Laparotomy -> ‘pelvic packing’
  • Pelvic angiography & embolization


Category: Karnataka PGET 2007 MCQs

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