MDCT Approach to Pelvic Trauma

1. MDCT Approach to Pelvic
Trauma
3rd
National Conference SER 2016
Bengaluru, India 23-25 September 2016
K.SHANMUGANATHAN

2. MDCT Approach to Pelvic
Trauma
• OBJECTIVE
• Anatomy – bony, ligaments
• Pelvic Fx - mechanism & classification
• Hemorrhage – surgical principles
• CT signs – guided management

3. Anatomy

5. 3 mm

7. Classification

8. LC
APC
Goals of Young-Burgess Classification
1.Predict the mechanism
2.Determine pelvic stability
3.Hemodynamic status

12. MDCT Approach to Pelvic
Trauma
• PELVIC Fx n = 234 /Yr
• LC pattern - 80%
• AP pattern - 14%
• VS pattern - 2%
• CMI pattern - 4%
SMH, ANP, ALJ. J.Trauma 2002;53:15-20

13. MDCT Approach to Pelvic
Trauma
• PELVIC Fx n = 234 /Yr
• Severe pelvic Fx - 16%
LC3, AP3, CMI, VS
• Less severe pelvic Fx - 84%
LC1, LC2, AP1, AP2
• Pelvic arteriography - 9%
SMH, ANP, ALJ. J.Trauma 2002;53:15-20

14. Imaging

15. Inlet
outlet

18. Pelvic Hemorrhage

19. Pelvic Fracture Hemorrhage
Morbidity & Mortality
• Hemorrhage - 14% – 52%
• Sepsis - 9%
• Urinary tract injury – 10% -15%
• Associate injuries – brain, diaphragm, solid
organ, organ failure

20. Pelvic Fracture Hemorrhage
Hemorrhage
• Arterial
• Venous plexus
• Bone

21. Pelvic Fracture Hemorrhage
Pelvic Hemorrhage
• Arterial - arteriography & embolization
• Bone – binder or external fixation
• Venous plexus – ?
• Extra pelvic – surgery or IR

22. PELVIC FRACTURE
HEMORRHAGE
Fracture Pattern & Hemodynamic
Instability
• Stable pelvic Fx - 70% peritoneal VS 10%
extra-peritoneal pelvic bleeding
• Unstable pelvic Fx - 40% peritoneal VS
60% extra-peritoneal pelvic bleeding

23. v = hπr2
/3

24. Pelvic Fracture Hemorrhage
OPTIMAL OUTCOME
• Multi-disciplinary approach
• Trauma surgeon
• Orthopedic surgeon
• Radiology (ER & IR)

25. MDCT Signs

26. LTRT

31. RT Iiac artery LT Iiac artery