virgola82
Forum Guru
Topics: 85
Posts: 348
|
An elderly pedestrian collides with a bycicle-riding pizza delivery man and suffers a unilateral fracture of hsi pelvis through the obturator foramen. You would manage this injury by
A. External pelvic fixation
B. Angiographic visualization of the obturator artery with surgical exploration if the artery in injured or constricted
C. Direct surgical approach with internal fixation of the ischial ramus
D. Short term bed rest with gradual ambulation as pain allows after 3 days
E. Hip spica
|
| kingsofke
Forum Guru
Topics: 24
Posts: 715
|
B. Aniographic visualization
___________________
In Life there are neither rewards nor punishments, just consequences.
|
| virgola82
Forum Guru
Topics: 85
Posts: 348
|
Apparently surgery (option B) is not easy to be performed in this area so bed rest (option D) should be better than surgical exploration and thus is said to be the right answer to this q. Anyway i still think that an arteriographic evaluation wouyld be necessary, but maybe the answer B is wrong because it also says to perform surgery... Didn't like this q that much: poorly written in my opinion
|
| sprint123
Forum Guru
Topics: 129
Posts: 870
|
But..Kaplan says External fixation is the best way to diminish the bleeding!
Any comments?
|
| dr_arc
Forum Senior
Topics: 5
Posts: 156
|
pelvic fracture but pt hemodynamically stable= observe and external fixation for the fracture, that might help in some way with the bleeding by stabilising the pelvis.cos pelvic surgeries is difficult business and might complicate things further
ref : kap notes.
|
| cirus
Forum Guru
Topics: 108
Posts: 740
|
ill would have gone for A, if he was unstable, but as his stable I think choice D is appropriate
|
| dr_arc
Forum Senior
Topics: 5
Posts: 156
|
but what abt the fracture cirus. you cannot mobilise a 3 day old fracture. you need to fix it externally.
|
| cirus
Forum Guru
Topics: 108
Posts: 740
|
The explan to this which i found irratinal on kaplan q bank ( almost same q) was that if his stable & hospital stay is not complicated, then this the ttt of choice as his pelvis is supported by strong tone that will help the healing & no need to intervent futher
honestly speaking i'm totally not convinced & on the test ill choose external fixation which i know is the ttt of choice for pelvic fractures, & i don't believe that bieng stable plays a role in the choice of ttt here..
so what do u think..?
|
| dr_arc
Forum Senior
Topics: 5
Posts: 156
|
stability , by which i assume you mean hemodynamic stability is important in the sense that a hemodynamically stable pt with a pelvic fracture is left alone save the mngmt of stabilising the pelvis most often by external fixation. even if the pt were bleeding there is no clear cut protocol to follow given the vagaries of pelvic surgery. embolizatiion helps only when the source of bleeding is arterial. even so external fixation is the best option, a stable pelvis definitely better than having broken jagged ends of a fracture cause further damage to bld vessels.
pestana has explained this well.
good luck cirus.
|
|
| |
| | | | | | | | | |
