Pelvic Trauma

Pelvic Trauma

Tullington Jessica E; Blecker Nathan

StatPearls

2020

2020-01

Traumatic injuries can range from minor wounds to major, complex injuries causing shock and multi-system organ dysfunction. Trauma is the leading cause of death of patients between the ages of 15 and 24. It accounts for approximately 30% of all ICU admissions annually.[1] Pelvic trauma raises concern due to the high energy that is generally required to cause the injury. It is frequently associated with additional injuries, transfusions requirements, and prolonged rehabilitation. The pelvis is a ring structure composed of bone. It consists of the sacrum, coccyx, and the innominate bones: the pubis, ischium, and ilium. The innominate bones join to form the acetabulum. The innominate bones join anteriorly at the pubic symphysis. It contains blood vessels, nerves, urogenital organs, and the rectum. The pelvis is anatomically associated with a number of vascular structures. The aorta divides into the common iliac arteries at about the L4 level. The common iliac arteries then further divide into the internal and external branches at the sacroiliac joint. The superior gluteal artery is the most commonly injured vessel in pelvic trauma; it branches from the internal iliac artery and exits the pelvis at the sciatic notch. Other intrapelvic arteries that are associated with injuries include the inferior gluteal artery, rectal arteries, obturator artery, and the vesical artery. Veins accompany the arteries and are also prone to injury. The proximity of the veins and arteries accounts for the high incidence of combined injury. The seriousness of pelvic fractures comes from the association of other injuries, as well as the potential for hematoma and hemorrhagic shock.[2] Hemorrhage from pelvic fractures is a major cause of morbidity and mortality. Nerve injuries are less common than vascular injuries with pelvic trauma. Lumbosacral plexus injuries account for the majority of nerve injuries after pelvic trauma. The plexus is in close proximity to the sacroiliac joint and the acetabulum, two of the more common pelvic injury locations. Root avulsion is possible and is typically only seen in more severe pelvic trauma. The lumbar plexus can be injured, though this is less common. Usually, injury occurs from traction or compression from a retroperitoneal bleed.[3]

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bookSection

NEOMED College of Medicine

Department of General Surgery

June 2020 Update I

Summa Health System