SAQ 105 – Trauma – pelvic fracture after low-energy fall

Question 2. pelvic fracture after low-energy fall.

a. X-ray abnormalities

• Right superior pubic ramus fracture.
• Left superior pubic ramus fracture.
• Left inferior pubic ramus fracture.
• Right partially displaced subcapital femoral fracture.
• Fracture through ischium extending to the right acetabulum.
• Bilateral hip osteoarthritis with reduced joint space, periarticular sclerosis, or osteophytes.

b. Further imaging

• eFAST.
• CT angiography pelvis, with consideration of embolisation.
• Contrast CT abdomen and pelvis.
• Cystogram, retrograde cystogram, or retrograde urethrogram.
• CT brain with or without CT cervical spine.
• Chest x-ray.

c. Analgesia approach

• Immobilise the legs.
• Apply a pelvic binder.
• Use haemodynamically cautious analgesia while hypotensive, such as IV fentanyl 25 microgram boluses or IV ketamine 5 mg boluses.
• Avoid unqualified IV morphine while haemodynamically unstable.
• Consider PCA if cognition and head injury status allow.
• Consider right femoral nerve block, for example bupivacaine 0.5% up to 2 mg/kg.