A motorcyclist in a high-speed accident presents with hypotension (BP 80/50 mmHg) and a pelvic X-ray showing widening of the symphysis pubis >2.5 cm with opening of the right sacroiliac joint. This is classified as Tile type B (open-book injury). The MOST IMMEDIATE life-saving intervention while resuscitation is ongoing is:

• A Application of a circumferential pelvic binder or sheet at the greater trochanter level ✓
• B Emergency angiographic embolization of internal iliac artery branches
• C External fixation of the pelvis in the operating room
• D Emergency retroperitoneal packing via laparotomy

Explanation

In hemodynamically unstable open-book pelvic fractures, the immediate first step is pelvic ring closure to reduce pelvic volume and tamponade venous bleeding from the presacral/paravesical plexus (majority of pelvic hemorrhage is venous). A circumferential sheet or commercial pelvic binder applied at the level of the greater trochanters compresses the pelvis and is the fastest, most immediately available intervention — it can be applied in the ED or even pre-hospital. Angioembolization, external fixation, and retroperitoneal packing come later in the resuscitation algorithm if hemorrhage persists, but none should precede binder application.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.