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PELVIC FRACTURES IN MOUNTAIN CASUALTIES IN SNOWDONIA: TO STRAP OR NOT TO STRAP?
  1. Hannah Browne,
  2. Linda Dykes
  1. Emergency Department, Ysbyty Gwynedd, Bangor, LL57 2PW, UK

    Abstract

    Background Mountain Rescue Teams in Snowdonia endeavour to use pelvic splints as per JRCALC guidelines. However, mountain casualties with major mechanisms of injury are often found in precarious locations where application of splints is challenging. We wondered whether the pelvic fractures seen in mountain casualties are of the type likely to benefit from splintage.

    Method The Bangor Mountain Medicine database (all casualties brought to Ysbyty Gwynedd following contact with MRT and/or RAF SAR helicopter) Jan 2004–October 2012 was interrogated and pelvic fracture cases identified.

    Fracture type was analysed from all available imaging using the Tile classification by a Consultant musculoskeletal radiologist. For fatalities, post-mortem reports were examined.

    Results

    • Of 913 casualties in the study period, 730 (80%) were injured rather than ill.

    • 18/730 (2.5%) of trauma casualties had a confirmed pelvic fracture.

    • 14/18 (78%) had fallen from height; 2 were mountain-biking; one crashed his paraglider and one sustained an acetabular fracture in a simple fall.

    • 4.3% of casualties who had fallen from a height greater than standing sustained a pelvic fracture.

    • 2/18 died at scene: post-mortem reports implied severe pelvic disruption but could not be classified further.

    • In a further 3 cases, imaging was not available, leaving 13 cases for radiological analysis.

    • 13/13 (100%) of fractures could be classified using the Tile system: 61% A1, 31% A2 and 8% C2.

    Conclusion Pelvic fractures are uncommon in Snowdonia mountain casualties, and, in survivors, the vast majority are stable (92%, cf. 55% in urban casualties). Severe pelvic disruption was seen only in casualties declared dead at scene.

    Only one casualty in a nine-year period had a pelvic fracture that might benefit from a pelvic splint. Our data suggests that application of pelvic splints need not be considered a high priority in mountain casualties, especially in precarious locations.

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