He managed to make it to the shore, get out of his wetsuit, and drive to the emergency department where described severe pain over the suprapubic area. His observations were all within normal range and with analgesia , he managed to mobilise and fully weight bear from wheelchair to bed , although with severe pain.
Examination showed tenderness over the symphysis pubis and the left side of the groin. The abdomen was soft otherwise and there were no other evident injuries. Lower limb examination was normal but range of movement of the left hip was restricted by pain in the left side of the groin.
An X-ray of the pelvis showed evidence of pelvic diastasis, and the left sacroiliac joint was suspicious for a potential fracture. After discussing with the orthopaedic team, a CT pelvis was obtained which confirmed pelvic diastasis with no associated fractures. There was also a 10*6*11 cm pelvic haematoma anterior to and compressing the urinary bladder. Both sacroiliac joints appeared normal, with an incidental cystic lesion noted lateral to the left sacroiliac joint.
The patient was admitted under the orthopaedic team, where two days later, he underwent an open reduction and internal fixation of the pelvic diastasis with a left sacroiliac screw insertion.
This presentation was particularly interesting to consider the possibility of ligamentous disruption to the symphysis pubic with abduction injuries.
N Bothma on behalf of Ahmed Abdelhadi (ED ST1)
The Derrifoam Blog
Welcome to the Derrifoam blog - interesting pictures, numbers, pitfalls and learning points from the last few weeks. Qualityish CPD made quick and easy.....