THE PELVIS: PART I THE PELVIC

WALLS
51-year-old man was involved in a
light-plane accident.

The pelvis is a bowl-shaped bony

structure that protects the terminal
parts of the gastrointestinal tract and
the urinary system and the male and
female internal organs of reproduction.

On landing, the plane came abruptly

to rest on its nose

It also contains important nerves,

blood vessels, and lymphatic tissues.

His companion was killed on impact,

and he was thrown from the cockpit.
He was unconscious and showed signs
of severe hypovolemic (loss of
circulating blood) shock.
-had extensive bruising of the lower
part of the anterior abdominal wall
- front of his pelvis was prominent on
the right side
-Radiographic examination of the
pelvis showed a dislocation of the
symphysis pubis and a linear fracture
through the lateral part of the sacrum
on the right side
-The urethra was damaged by the
shearing forces applied to the pelvic
area, which explained the bloodstained fluid from the external orifice
of the penis.
The pelvic radiograph (later confirmed
on computed tomography scan) also
revealed the presence of a large
collection of blood in the loose
connective tissue outside the
peritoneum, which was caused by the
tearing of the large, thin-walled pelvic
veins by the fractured bone and
accounted for the hypovolemic shock.
Chapter Objectives

Basic anatomy
Pelvis
lies

- is the region of the trunk that

below the abdomen.

Pelvis
-main function: transmit the
weight of
the body from the
vertebral column to
the femurs
-contains, supports, and
protects the
pelvic viscera
and

and
walls

-provides attachment for trunk

lower limb muscles.
-composed of four bones:
1. Two hip bones
- form the lateral
anterior
2. sacrum

3. coccyx which are part

of the
vertebral column
and form the
back
wall (Fig. 6.1).

-2 hip bones articulate with

each other anteriorly at the
symphysis pubis and
posteriorly
with the sacrum at the
sacroiliac
joints.

-bony pelvis thus forms a strong

basin- shaped structure that contains
and protects the lower parts of the
intestinal and urinary tracts and
the
internal organs of reproduction.

-bounded :
behind - lumbar
vertebrae

pelvis is divided into two parts by:

laterally-the iliac fossae &

iliacus muscles

Behind - pelvic brim, which is

formed
by the sacral promontory
(anterior and
upper
margin of the first sacral vertebra)

front- lower part of the

abdominal wall.

Laterally- iliopectineal lines (a

line that
runs downward and
forward around the
inner
surface of the ileum)
Anteriorly- symphysis pubis
(joint between bodies of pubic bones)
false pelvis
- Above the brim
-which forms part of the
abdominal
cavity
true pelvis
-Below the brim
Orientation of the Pelvis
front of the symphysis pubis
and the
anterior superior iliac
spines should lie
in the same
vertical plane
-it means that the pelvic surface
of the
symphysis pubis faces
upward and backward
-the anterior surface of the
sacrum is
directed forward and
downward.
False Pelvis
-is of little clinical importance.

anterior

-flares out at its upper end >

should be
considered as part of the
abdominal cavity.
-supports the abdominal
contents
-after the 3rd month of
pregnancy helps
support the gravid
uterus.
-During the early stages of
labor, it
helps guide the fetus into
the true
pelvis.
True Pelvis
-bony canal through which the
child passes during birth
-has an inlet, an outlet, and a
cavity

pelvic inlet, or pelvic brim

(Fig. 6.2)
-is bounded:
posteriorly- sacral
promontory
laterally- iliopectineal
lines
anteriorlysymphysis pubis
(Fig.6.1).

 pelvic outlet (Fig. 6.2)

is bounded by:
posteriorly- coccyx
laterally- ischial
tuberosities
anteriorlypubic arch (Figs. 6.2
and
6.3)
pelvic outlet has three wide
notches:
Anteriorly, the pubic arch
is between the ischiopubic rami, and

laterally are the sciatic notches. The

sciatic notches are divided by the
sacrotuberous and sacrospinous
ligaments (Figs. 6.1 and 6.2) into the
greater and lesser sciatic foramina
(see page 246). From an obstetric
standpoint, because the sacrotuberous
ligaments are strong and relatively
inflexible, they should be considered
to form part of