Open book pelvic fracture

• Results from an anteroposterior compression injury to the pelvis
• Often seen in elderly falls vs MVA or other high speed trauma
• Causes disruption of pubic symphysis and the pelvis opens like a book
• Results in tears of the strong pelvic ligaments that hold the pelvis bones together
• Large arteries pass near these ligaments and can get torn resulting in massive blood loss

• pelvic/Hip pain
• Unstable pelvis
• hypotension if large amounts of bleed
• Consider concomitant GU injury

• Unstable pelvis on exam
• Xr pelvis in acute trauma setting
• CT Pelvis

• Stabilize fracture with pelvic binder or bed sheet wrapped around greater trochanter (physician's often make mistake of wrapping around the iliac crest)
• If suspect pelvic injury and patient is unstable, place pelvic binder/sheet immediately then obtain X-ray when patient is stable
  • If patient persistently hypotensive even after binder and suspect pelvic artery bleed consider IR for embolization
• Long term management requires orthopedic consultation

• Hypotension from exsanguination
• infection
• Loss of function
• Genitourinary injury

Admission

• Pelvic fractures