Contents
Etiology
- high energy trauma
- generally multiple lower extremity and/or pelvic fractures
- may be associated with spinal or life threatening injuries
|| Orthopaedic Emergencies VON CHOP
||: vascular compromise
: open #
: neurologic compromise/cauda equina syndrome
: compartment syndrome
: hip dislocation
: osteomyelitis/Septic arthritis
: unstable pelvic #
Clinical Presentation
- local swelling, tenderness, deformity of the hips and instability of the pelvis with palpation
Investigations
- routine views of pelvis: AP, inlet, outlet and Judet (iliac oblique and obturator oblique) views, push-pull views to assess rotational and vertical instability
- AP and lateral XR of all long bones suspected to be injured
 |
PEARL
vascular status of a deformed extremity can be evaluated by palpation of pulses, Doppler exam of pulses & the ankle brachial index (normal ABI > 90%) |
Management
- ABCDE
- assess genitourinary injury (DRE/vaginal exam mandatory)
- external or internal fixation of all fractures, pelvic binding in ED
Complications
- hemorrhage – life threatening
- ARDS
- fat embolism syndrome
- pulmonary embolism
- bladder/bowel injury
- neurological damage
- obstetrical difficulties in future
- persistent SI joint pain
- post-traumatic arthritis of the hip with acetabular fractures
References
Insert recent references and landmark articles