A 30-year-old motorcyclist is brought to the emergency department after a head-on collision. He is hemodynamically unstable (BP 70/40 mmHg, HR 130). Pelvic X-ray shows widening of the pubic symphysis >2.5 cm and widening of the right sacroiliac joint. Tile/Young-Burgess classification is APC (anteroposterior compression) Type II. The immediate priority is:

• A Application of pelvic binder or sheet at the level of greater trochanters to close the pelvic ring ✓
• B Emergency CT pelvis to classify fracture precisely before any intervention
• C Immediate external fixator application in the operating room
• D ORIF of symphysis pubis as primary hemorrhage control

Explanation

In hemodynamically unstable pelvic ring disruption, the first step is emergent reduction of pelvic volume to tamponade venous and bony bleeding — this is achieved by a circumferential pelvic binder (or sheet wrap) placed at the level of the greater trochanters, not the iliac crests. APC II injuries open the pelvic ring anteriorly and posteriorly, dramatically increasing pelvic volume and blood loss cavity. CT is obtained after initial resuscitation and binder application. External fixator is a definitive early stabilization but requires operative setup; binder is faster. ORIF is deferred until the patient is haemodynamically stabilized.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.