An elderly male pedestrian collides with a bicycle-riding

Discussion in 'MRCS Forum' started by Lona., Dec 19, 2007.

  1. Lona.

    Lona. Guest

    An elderly male pedestrian collides with a bicycle-riding pizza delivery man and suffers a unilateral fracture of his pelvis through the obturator forearm. You would manage this injury by -
    a- External pelvic fixation
    b- Angiographic visualization of the abturator artery with surgical exploration if the artery is injured or constricted
    c- Direct surgical approach with internal fixation of the ischial ramus
    d- Short-term bed rest with gradual ambulation as pain allows after 3 days
    e- Hip spica
  2. Lona.

    Lona. Guest

    Answer: d. (Schwartz, 7/e, pp 169, 204) Most pelvic fractures are the result of automobile-pedestrian accidents, and these fractures are a frequent cause of death. The pelvis is extremely vascular with a diffuse blood supply that makes hemorrhage common and surgical control of bleeding difficult. This patient has a type II fracture (single break in pelvic ring) through a non-weight-bearing portion of the pelvis. These fractures are best treated by bed rest until hemodynamic stability is ensured and thereafter by gentle ambulation as pain permits. The clinician must watch carefully for associated injuries to the bladder, urethra, and colon and be alert to the many other possible concurrent injuries to an elderly patient who has suffered a collision, even a low-velocity attack from a pizza man.

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