April 26, 2012

Image of the Day 8: Open book fracture

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

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]

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.


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