Pediatric emergency medicine trisk 3487 3487
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PELVIC RING FRACTURES . Single breaks in the pelvic ring occur with symphysis
pubis diastasis, superior and inferior pubic rami fracture, and straddle fractures.
These are generally considered stable fractures. One exception to this is with the
open book deformity when diastasis of the pubic symphysis occurs with anterior
disruption of the sacroiliac joint. With significant disruption of the symphysis
pubis, closed reduction and fixation must be considered.
Unstable fractures of the hemipelvis occur when fractures of the pubic rami or
symphysis pubis are associated with a displaced sacroiliac joint dislocation or
sacral fractures (Malgaigne fractures) ( Fig. 111.33 ). These fractures are
associated with a high incidence of injuries to adjacent structures, and lifethreatening hemorrhage can occur from pelvic vein injury, which may require
angiographic embolization for persistent bleeding. Unstable pelvic fractures are
initially managed with bed rest. Urgent orthopedic consultation is recommended
for pelvic ring fractures.
