A 30-year-old victim of a high-speed motor vehicle accident has an open-book pelvic injury with pubic symphysis diastasis of 5 cm on AP X-ray, hemodynamic instability, and blood pressure of 80/50 mmHg. The immediate life-saving intervention is:

• A Emergency external fixation of the pelvis
• B Immediate CT angiography and embolization
• C Exploratory laparotomy
• D Application of a pelvic binder (circumferential sheet/commercial binder) to close the pelvic ring ✓

Explanation

Open-book pelvic injury (Tile APC II/III, Young-Burgess APC II/III) causes massive retroperitoneal venous bleeding from disruption of the anterior pelvic venous plexus. The immediate priority in the hemodynamically unstable patient is pelvic ring closure using a circumferential pelvic binder or wrapped sheet at the level of the greater trochanters, which reduces pelvic volume and provides tamponade effect, buying time. External fixation is next but takes longer to set up. CT angiography and embolization address arterial bleeding and are appropriate after initial stabilization. Laparotomy is indicated for intraabdominal hemorrhage, not retroperitoneal pelvic bleeding.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.