1. Image of the Day 8: Open Book Fracture
by: Muhamad Na’im Ab Razak (M.D USM)
As the title speaks for itself, today's image of the day will briefly highlight about open book
fracture. Generally, pelvic fracture occurs as a result of high energy injuries and often involve
other organ or system.
Associated injury to the head, chest and abdomen should be look for. Apart from that, soft
tissue injury, hemorrhagic shock (from exposed fracture, vein and artery), urethral injury,
fracture dislocation of adjacent bone or joint, neurovascular injury and lumbosacral nerve
injury should always be anticipated
For example in this patient who is a 40 years old gentleman who trap inside his tractor when it
fall from three meters height also sustains blunt cardiac injury, unstable left hip dislocation
and intra abdominal injury.
While stabilization taking place in emergency department, management of this patient
requires multi disciplinary approach especially, orthopedic, surgical, medical and
anesthesiologist. Early intervention may save life and reduce the morbidity of the patient.
AP view pelvic plain radiograph shows completely disruption of pubic tubercle

2. Stabilization of pelvic fracture with External fixator. previously, conservative management is
the preferred management but with the advance in orthopedic surgery, one may also consider
internal fixation.
For more understanding regarding pelvic fracture, read this two articles in Medscape
1) Pelvic fracture [link]
2) Pelvic fracture in Emergency Medicine [link]

3. And this is the ECG of this patient which shows deep S wave, ST elevation and tall but
narrow T wave in lead V1 till lead V5. His blood cardiac enzyme marker also rises
significantly.