Page 654 - ACCCN's Critical Care Nursing

Trauma Management 631

infection risk and require surgical treatment within l Fractures of the pelvis. The pelvis is the largest com-
8 hours. 50,51 bined bony structure in the body and serves to provide
l Traumatic amputation. Amputation refers to an avul- an essential supporting framework for ambulation
sion in which the affected limb or body appendage is and protection of pelvic organs. Major blood vessels
completely separated from the body. This can occur and nerves traverse the pelvic bones, supplying the
when a digit or extremity is sheared off by either lower limbs and pelvic organs. Therefore, injury to
mechanical or severing forces, for example amputa- any part of the pelvis is serious. The three bones that
tion of a thumb by a bandsaw. Traumatic amputations comprise the pelvic ring are the two innominate
vary in severity and ongoing compromise, with a bones (ilium and pubic rami) and the sacrum. Due
cleancut amputation more likely to be successfully to its reinforced structure, the amount of force
reattached than a crushed extremity. Criteria that required to fracture the pelvis is substantial. Fractures
inform the surgical decision-making process include of the pelvis can affect one or both sides of the pelvis,
the amount of tissue loss, location on the body at the and be stable or unstable. A variety of classification
connection site, damage to underlying and surround- systems exist to describe the severity of pelvic frac-
ing tissues, bones, nerves, tendons/muscles and tures, the most common being the Tile classification
vessels, and condition of the amputated part. (see Figure 23.2).

Tile A

A1 A2 A3
Avulsion injury Stable Transverse fractures of
Not involving the ring Minimal displacement sacrum or coccyx

Tile B

B1 B2 B3
Unilateral Lateral compression injury Bilaterally rotational instability
Internal rotation instability
Tile C

C1 C2 C3
Unilateral Bilateral Bilaterally vertically unstable
One side rotationally unstable
One side vertically unstable
FIGURE 23.2 Tile classification for pelvic fractures.
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