FRACTURE WITH LARGE PELVIC RING OPENING WITHOUT HEMODYNAMIC INSTABILITY

OBSERVATORY STUDY

Abstract

Pelvic fractures, usually the result of high-energy trauma such as car accidents and falls, are associated with significant morbidity and mortality due to the possibility of retroperitoneal bleeding and the risk of immediate death. Clinical indicators of pelvic injury include urethral bleeding, abdominal pain, perineal ecchymosis and prostatic elevation on rectal touch, while genitourinary injuries occur in up to 15% of cases, especially in previous fractures. Bladder catheterization is contraindicated in these cases and retrograde urethrocystography is necessary. Rapid stabilization with external fixators, associated with ATLS care protocols, plays a fundamental role in reducing morbidity and mortality. Unstable pelvic fractures require immediate intervention to avoid fatal complications. This study analyzes a case of pelvic trauma in a 47-year-old patient who was the victim of a collision between a motorcycle and a car. The patient was admitted without loss of consciousness, receiving volume replacement and analgesia during transportation. The examinations revealed bilateral wrist fractures, a combined pelvic fracture and a knee dislocation. On the fifth day, edema and hematoma of the labia majora were observed, without bleeding. The pelvic fracture presented an opening of 7.3 cm in the pubic symphysis, but without hemodynamic instability, characterizing a fracture of high severity, according to the Young and Burgess classification, which considers openings greater than 2.5 cm as indicative of severe injuries. Despite this, the patient was clinically stable, allowing for scheduled fixation and more time for surgical planning. Pelvic fractures in high-energy trauma require careful and early management, and the application of protocols such as ATLS favors a more positive prognosis. Emergency clinical management, especially in complex fractures, is essential, although imaging tests are indispensable to verify pelvic instability and classify fractures. The diagnosis of pelvic fractures requires active investigation of associated injuries and strict control of possible retroperitoneal bleeding.