Pelvic Injuries (MBBS India)

The pelvis consists of the bony pelvic girdle, the muscular and ligamentous pelvic floor, and the pelvic cavity, which contains viscera, vessels, and multiple nerves and muscles. The pelvic girdle, composed of 2 “hip” bones and the sacrum, is a ring-like bony structure of the axial skeleton that links the vertebral column with the lower extremities. The pelvic ring joints include the pubic symphysis anteriorly and the sacroiliac joints posteriorly. The hip bones are made up of 3 fused bones: the pubis, ischium, and ilium. The pelvic cavity houses various GI, urinary, and reproductive structures, which are supported by the muscles and connective tissue of the pelvic floor. The female pelvis, making accommodations for childbirth, is generally wider and larger than the male pelvis.

The urinary tract is located in the abdomen and pelvis and consists of the kidneys, ureters, urinary bladder, and urethra. The structures permit the excretion of urine from the body. Urine flows from the kidneys through the ureters to the urinary bladder and out through the urethra. The bladder acts as a reservoir for urine until micturition is appropriate. Regulation of micturition relies on the CNS and the spinal cord.

Focused assessment with sonography for trauma is a point-of-care ultrasound examination protocol for the abdominal and thoracic cavities performed in the emergency room as part of the secondary survey in advanced trauma life support. The main goal of the FAST exam is to identify free intraperitoneal fluid (blood) and pericardial effusion from trauma. As FAST requires only an ultrasound machine at the bedside and an experienced sonographer, it is widely available, quicker, and less invasive than other image modalities. Focused assessment with sonography for trauma has largely replaced diagnostic peritoneal lavage.

Penetrating abdominal injuries are created by an object puncturing the abdominal wall. Injuries can be high velocity, like gunshot wounds, or low velocity, like stab wounds. Different structures can be injured, including the duodenum, spleen, liver, kidneys, and pelvic organs. The extent and specific type of abdominal traumatic injury can be identified by a proper history and physical exam and supported by appropriate imaging studies. Management, which can be laparotomy or a conservative approach, is dependent on the patient’s hemodynamic stability and specific type of injury.

Traumatic injuries to the genitourinary (GU) tract include injuries to the kidneys, ureter, bladder, urethra, or genitals. Typically, injuries to the GU tract alone are not life threatening, but can be associated with other potentially more significant injuries. The GU system is divided into the upper GU tract (kidneys and ureters) and the lower GU tract (bladder, urethra, and external genitalia). Mechanisms include blunt and penetrating injuries. Diagnosis relies on thorough physical exam and imaging. Management depends on the severity of injury and ranges from simple observation and supportive measures to major surgical interventions. Timely diagnosis and intervention are crucial for preventing complications and ensuring optimal outcomes.

Abdominal injuries are classified according to their mechanism of injury as blunt or penetrating. In blunt abdominal trauma, the bowel, spleen, liver, kidneys, and pelvic organs can be injured. The extent and specific type of abdominal traumatic injury can be identified by a proper history and physical examination and confirmed by appropriate imaging studies. Management depends on the patient’s stability and specific type of injury.