“Open Book” Pelvis/Hemodynamically

Unstable Pelvis Fracture

What It Is

• “Open book” pelvis refers to a pelvic ring injury where the entire pelvis becomes
unstable. Multiple arteries and veins course along the inside of the pelvis and can
cause significant bleeding.
(Open Book Pelvis)

Why It’s an Emergency

• Until the pelvis is stabilized, the intra-pelvic bleeding can continue, which makes
this a life-threatening emergency.

How “Emergent” Is It?

• Truly emergent. This is life threatening and complications can occur on the
order of minutes.

When to Be Suspicious

• High-energy trauma patients with persistent hemodynamic instability

© Springer International Publishing Switzerland 2017 31

M.C. Makhni et al. (eds.), Orthopedic Emergencies,
DOI 10.1007/978-3-319-31524-9_10
32 J. Shillingford

How to Diagnose

• Part of the secondary survey of ATLS protocol should involve checking pelvic
stability on exam.
• Additionally, basic ATLS protocol should also include an AP pelvis X-ray.

How to Treat

• Initial treatment is immediate placement of pelvic binder or wrapping with pel-

vic sheet (see section “Pelvic Sheet/Binder application,” in chapter “Initial
Trauma Assessment”), which usually provisionally stabilizes the pelvis enough
to initiate further work-up.
• Secondary treatment may involve some combination of angiography/emboliza-
tion by interventional radiology, open pelvic packing by general surgery, and/or
emergent operative pelvic stabilization (external fixation +/− posterior SI
fixation).

References

Croce MA, Magnotti LJ, Savage SA, Wood 2nd GW, Fabian TC. Emergent pelvic fixation in
patients with exsanguinating pelvic fractures. J Am Coll Surg. 2007;204(5):935–9.
Krieg JC, Mohr M, Ellis TJ, Simpson TS, Madey SM, Bottlang M. Emergent stabilization of
pelvic ring injuries by controlled circumferential compression: a clinical trial. J Trauma.
2005;59(3):659–64.
Manson TT, Nascone JW, Sciadini MF, O’Toole RV. Does fracture pattern predict death with lat-
eral compression type 1 pelvic fractures? J Trauma. 2010;69(4):876–9.