A 30-year-old motorcyclist sustains a high-energy pelvic fracture with pubic symphysis diastasis of 4 cm and sacroiliac joint widening on AP pelvis X-ray. He is hemodynamically unstable despite 2L crystalloid resuscitation. The FIRST step in the orthopaedic management of this pelvic ring injury is:

• A Emergency percutaneous iliosacral screw fixation
• B Formal open reduction and internal fixation of the pubic symphysis
• C Diagnostic peritoneal lavage
• D Application of a pelvic binder or external fixator to reduce pelvic volume ✓

Explanation

In hemodynamically unstable pelvic ring injuries (APC type II/III or VS patterns), the immediate priority is pelvic volume reduction to tamponade venous bleeding — achieved rapidly with a pelvic binder (sheet or commercial device at the level of the greater trochanters) or an emergency external fixator. This reduces pelvic volume by up to 25%, decreasing venous bleeding. Definitive fixation (ORIF/percutaneous SI screws) is delayed until the patient is hemodynamically stable. Pelvic binder application is a resuscitative measure, not definitive treatment.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.