FRAKTUR PELVIS

Kusvandita Giopratiwi 1610211047

DEFINISI
 Fraktur adalah hilangnya kontinuitas tulang, baik bersifat total maupun parsial.

 The term pelvic fractures is typically restricted to fractures of the pelvic ring.

Tortora Principles of Anatomy and Physiology 14e

In severe pelvic injuries the membranous urethra is damaged when the prostate
is forced backwards whilst the urethra remains static. When the puboprostatic
ligament is torn, the prostate and base of the bladder can become grossly
dislocated from the membranous urethra.

Ruptur Urethra
EPIDEMIOLOGY
 Fractures of the pelvis account for less than 5 per cent of all skeletal injuries

 About two-thirds of all pelvic fractures occur in road accidents involving pedestrians

 Over 10 per cent of these patients will have associated visceral injuries

 In this group the mortality rate is probably in excess of 10 per cent.

ETIOLOGY
 Pelvic fractures occur after both low-energy and high-energy events.

 Low-energy pelvic fractures occur commonly in two distinct age groups: adolescents and

the elderly. Adolescents typically present with fractures of the superior or inferior iliac
spines  result from an athletic injury. Low-energy pelvic fractures in the elderly
frequently result from falls while ambulating.
 High-energy pelvic fractures most commonly occur after motor vehicle crashes.
CLASSIFICATION
 Stable Injuries :

 Stable injuries involve only one side of the ring. Examples include direct-impact fracture of

the sacrum, coccyx, or iliac wing and pubic ramus fractures associated with low-energy falls in
osteoporotic elderly individuals

 Unstable Injuries :

 Unstable pelvic fractures include fracture and/or ligamentous disruption in two parts of the ring.

Examples include straddle injuries with bilateral superior and inferior pubic rami
fractures, open book fractures with disruption of symphysis pubis.
Orthopedics__Netters_Orthopae 1st ed
Orthopedics__Netters_Orthopae 1st ed
Sobotta Atlas of Anatomy, 15E
Orthopedics__Netters_Orthopae 1st ed
CLINICAL MANIFESTATION
 Severe pain  This pain is aggravated by moving the hip or attempting to walk.
 There may be swelling or bruising of the lower abdomen, the thighs, the perineum, the
scrotum or the vulva. All these areas should be rapidly inspected
DIAGNOSIS
 Assess the patient’s general condition and look for signs of blood loss.

 The pelvic ring can be gently compressed from side to side and back to front.Tenderness over

the sacroiliac region is particularly important and may signify disruption of the posterior
bridge.

 A rectal examination is then carried out in every case. The prostate position should be gauged;

an abnormally high prostate suggests a urethral injury.

 Enquire when the patient passed urine last and look for bleeding at the external meatus. An

inability to void and blood at the external meatus are the classic features of a ruptured
urethra.
 The absence of blood at the meatus does not exclude a urethral injury, because the external

sphincter may be in spasm, halting the passage of blood from the site of injury. Thus every
patient who has a pelvic fracture must be considered to be at risk

 The patient can be encouraged to void; if he is able to do so, either the urethra is intact or there

is only minimal damage which will not be made worse by the passage of urine.

 If the patient is unconscious early x-ray examination is essential in these cases.

 If any serious injury is suspected, a CT scan at the appropriate level is extremely helpful
 If there is evidence of upper abdominal injury, and the patient has haematuria,

an intravenous urogram is performed to exclude renal injury. This will also

show whether there is any ureteric or major bladder damage. In a case of
urethral rupture.

 An urethrogram should be undertaken using 25–30ml of water-soluble

contrast agent with suitable aseptic technique  extravasation?

MANAGEMENT
 Early management

 With any severely injured patient, the first step is to make sure that the airway is clear and ventilation

is unimpaired. Resuscitation must be started immediately and active bleeding controlled.If necessary,
painful fractures are splinted  A single anteroposterior x-ray of the pelvis is obtained.

 Management of severe bleeding  tamponade effect

 Managmenet of urethra and bladder  catheter may be required to monitor urinary output,

suprapubic cystostomy to evacuating the pelvic haematoma and then threading a catheter
across the injury to drain the bladder.
COMPLICATION
 Thromboembolism A careful watch should be kept for signs of deep vein

thrombosis.

 Urogenital problems : urethral injuries sometimes result in stricture,

incontinence or impotence and may require further treatment.

 Persistent sacroiliac pain Unstable pelvic fractures are often associated with

partial or complete sacroiliac joint disruption, and this can lead to persistent
pain at the back of the pelvis.
REFERENCES
 Apley’s System of Orthopaedics and Fractures 9e
 Orthopedics__Netters_Orthopae 1st ed
 Sobotta Atlas of Anatomy, 15E
 Tortora Principles of Anatomy and Physiology 14e