EMERGENCY DEPARTMENT EVALUATION AND TREATMENT OF PELVIC FRACTURES - 05/09/11

Doi : 10.1016/S0733-8627(05)70106-1

Paolo T. Coppola, MD ^a, Marco Coppola, DO, FACEP ^b

^a Brookhaven Memorial Hospital, East Pathogue, New York (PTC)

^b Department of Emergency Medicine, Texas A&M University System Health Science Center; and Emergency Medicine Residency, Scott and White Memorial Hospital, Temple, Texas (MC)

Résumé

Pelvic fractures are among the most serious injuries and account for 3% of all fractures.^{28 Peltier L.F. Complications associated with fractures of the pelvis J Bone Joint Surg 1965 ; 47 : 1060

Cliquez ici pour aller à la section Références} About 60% result from vehicular trauma (e.g. automobile, motorcycle, bicycle), 30% from falls, and 10% from crush injuries, athletic injuries, or penetrating trauma.^{18 Jerrard D.A. Pelvic fractures Emerg Med Clin North Am 1993 ; 11 : 147-163

Cliquez ici pour aller à la section Références, 23 Moreno C., Moore E.E., Rosenberger A. , et al. Hemorrhage associated with major pelvic fracture: A multispecialty challenge J Trauma 1986 ; 26 : 987-994 [cross-ref]

Cliquez ici pour aller à la section Références} Pelvic fractures are the third most commonly seen injury in fatalities due to motor vehicle accidents.^{24 Mucha P., Farnell M.B. Analysis of pelvic fracture management J Trauma 1984 ; 24 : 379-385 [cross-ref]

Cliquez ici pour aller à la section Références}

Life-threatening hemorrhage, deformity, neurologic injury, and genitourinary (GU) injury are all potential complications that must be identified and treated early in the setting of pelvic fractures. The literature shows that the mortality rate has varied from 9% to 20% in the 1970s and has seemed to decrease in the 1980s to 6% to 10%.^{6 Connoly W.B., Hedberg E.A. Observations on fractures of the pelvis J Trauma 1969 ; 9 : 104-111

Cliquez ici pour aller à la section Références, 18 Jerrard D.A. Pelvic fractures Emerg Med Clin North Am 1993 ; 11 : 147-163

Cliquez ici pour aller à la section Références, 20 Looser K.G., Crombie H.D. Pelvic fracture: An anatomic guide to severity of injury Am J Surg 1976 ; 132 : 638 [cross-ref]

Cliquez ici pour aller à la section Références, 24 Mucha P., Farnell M.B. Analysis of pelvic fracture management J Trauma 1984 ; 24 : 379-385 [cross-ref]

Cliquez ici pour aller à la section Références} Despite this apparent decrease, pelvic fractures pose a formidable clinical challenge to the emergency physician (EP). Hemodynamically unstable patients who present to the Emergency Department (ED) with a pelvic fracture have a mortality rate of 40% to 50%.^{23 Moreno C., Moore E.E., Rosenberger A. , et al. Hemorrhage associated with major pelvic fracture: A multispecialty challenge J Trauma 1986 ; 26 : 987-994 [cross-ref]

Cliquez ici pour aller à la section Références}

Many classification schemes have been proposed to try to simplify or organize the many types of pelvic fractures. These have limited value for the EP owing to their complexity and because they offer little for the immediate management of the patient. The following pages discuss pelvic anatomy and attempt to classify pelvic fractures into categories that correlate to the risk of complications and orthopedic instability.

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