Closing the Ring Without Springing It: Pedestrian Struck With Open-Book Pelvic Fracture
Closing the Ring Without Springing It: Pedestrian Struck With Open-Book Pelvic Fracture - Trauma Surgery clinical simulation case. 34-year-old male...
Age: 34 • Gender: Male • Setting: Emergency Triage
Clinical Presentation & History
34-year-old male pedestrian struck by a moving vehicle at moderate speed approximately 25 minutes ago. Transported by EMS with cervical collar, long spine board, and two large-bore IVs in place. Hypotensive with widened pubic symphysis on screening pelvic radiograph.
Acute Resuscitation Milestones & Priorities
Clinical phases and key interventions encountered in this emergency module:
Phase 2B – Imaging & Decision Branching (Trauma Bay → CT vs IR)
Phase 3 – Definitive Hemorrhage Control & Disposition
High-Yield Clinical Pearls
The single most important action in open-book pelvic fracture is circumferential binder compression at the GREATER TROCHANTERS, not over the iliac crests. Trochanteric placement rotates the pelvic ring closed around the sacrum.
Manual springing of the pelvis is OBSOLETE once an AP radiograph demonstrates instability. Springing disrupts clot and accelerates hemorrhage.
Approximately 80% of pelvic fracture hemorrhage is venous (presacral plexus, internal iliac venous tributaries). Binder tamponades this; arterial bleeding (20%) requires angioembolization.
Massive transfusion in pelvic trauma uses 1:1:1 PRBC:FFP:platelet ratio and TXA 1g IV within 3 hours of injury.
Keep the binder in situ throughout CT imaging and transport. Image artifact is acceptable; re-bleeding is not.
Definitive external fixation or internal ring fixation is performed within 24–72 hours once physiology is normalized and any arterial source has been embolized.
Test Your Clinical Reasoning in Real Time
Step into the active clinician role for this case. Order diagnostic tests, analyze live laboratory panels, and navigate branching clinical decisions with real-time feedback.