A 35-year-old man presents after high-speed MVA with pelvic ring disruption (open book injury) and hypotension (BP 80/50, HR 130). FAST shows no free fluid. Pelvic X-ray confirms symphyseal diastasis of 5 cm. The first intervention to control pelvic haemorrhage is:
- A Emergency laparotomy and pelvic packing
- B Application of a pelvic binder or external fixator to reduce pelvic volume, followed by angioembolisation if haemorrhage persists ✓
- C Bilateral common iliac artery ligation
- D FAST-guided peritoneal lavage
Correct answer: B. Application of a pelvic binder or external fixator to reduce pelvic volume, followed by angioembolisation if haemorrhage persists
Explanation
An open-book pelvic fracture causes haemorrhage primarily from venous and bony surfaces; closing the pelvic ring with a pelvic binder (emergency) or external fixator reduces the pelvic volume, tamponading venous bleeding. If haemodynamic instability persists after ring closure, CT angiography followed by catheter-directed angioembolisation targets arterial bleeding. Preperitoneal pelvic packing is used when angioembolisation is unavailable.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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