A 32-year-old is brought to the emergency department after a motorcycle crash. Radiograph shows a widening of the pubic symphysis (> 2.5 cm) and disruption of the sacroiliac joint unilaterally with posterior displacement. He is hypotensive despite resuscitation. According to the Young–Burgess classification, this is an Anterior–Posterior Compression Type III (APC III) injury. The most immediately life-saving intervention is:

• A Emergency open reduction and internal fixation of the pubic symphysis
• B Retroperitoneal packing alone
• C Emergency cystogram to exclude bladder injury
• D Pelvic binder application or C-clamp/external fixator followed by angiographic embolisation if haemostasis not achieved ✓

Explanation

APC III (open-book) pelvic injuries dramatically increase pelvic volume, allowing massive retroperitoneal haematoma. Immediate volume reduction with a pelvic binder (or C-clamp in the resuscitation bay) closes the pelvis, tamponades bleeding, and is the priority. If haemodynamic instability persists despite binder and resuscitation, angiographic embolisation (for arterial bleeding) or pre-peritoneal packing is performed. Definitive ORIF is deferred until the patient is stabilised.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.