Perioperative considerations in major orthopedic trauma: pelvic and long bone fractures.

Although pelvic fractures constitute a small percentage of total orthopedic injuries, they are associated with highest mortality rate. Pelvic fractures, along with long bone fractures, frequently are the result of significant blunt trauma often encountered in high-speed motor vehicle accidents. However, other types of trauma can cause these devastating injuries. Early recognition and a high index of suspicion are necessary to ensure that effective and aggressive resuscitation is instituted immediately. Expeditious assessment in the emergency department and care of the patient with pelvic and long bone fractures will greatly enhance the ongoing resuscitation in the operating room. Potentially life-threatening associated injuries in these patients make resuscitation even more challenging. Therefore, a basic knowledge of the mechanisms of injury, early treatment in the emergency department, and the factors that affect intraoperative management will help optimize the outcome for patients with these injuries. This course describes the perioperative concerns and the evaluation and treatment of a patient with a pelvic or a long bone fracture.