PELVIC

FRACTURE
Referat Trauma

Rifki Albana
Introduction
■ Pelvis  Transition from trunk to lower extremities
■ pelvis  protect structures in the pelvic cavity
■ Pelvic fracture
– Etiology  5% of all trauma patients
– High incidence of soft tissue injuries
– 10% visceral injuries  Higher mortality (>10%)
– Mortality  6 – 50%
■ Diagnosis and management
ANATOMY
 Anatomy
■ Pelvis  ring-like structure
– 2 innominate bone
■ Each  Ilium, sacrum,
pubis
■ Joins posterior sacrum
at sacroiliac (SI) joint
– 1 sacral bone
■ Innervation
– Lumbar, sacral, coccygeal
plexus  formed by
anterior rami T12 – S4
■ The stability given by the posterior SI ligament must be able to withstand body weight
transmitted through the SI ligament to the lower extremity.
■ Symphysis serves as a body support for maintaining the structure of the pelvic ring.
■ 2 COLLUM:
– anterior:
■ iliac wing
■ anterior wall
acetabulum
■ Superior pubic ramus
■ Inferior pubic ramus
■ Pubic tuberce
– Posterior:
■ Greater sciatic notch
■ Lessersciatic notch
■ Ischial spine
■ Ischial tuberosity
■ Posterior wall
acetabulum
ANATOMY
 Diagnosis
■ History Taking
– Previous history of trauma
– Trauma mechanism
■ Physical Examination
– Primary survey
■ Airway
■ Breathing
■ Circulation
– primary survey  identification and immediate
management of the threat of life.
 Diagnosis
■ Secondary Survey
– Palpation of anterior superior iliac spines
■ Stability at internal and external rotation
– Signs of laceration
– Digital rectal examination / vaginal touche
■ Any bone fragments penetrating rectum / vagina?
■ Bulbocavernosus and cremaster reflexes
– Blood from meatal urethra  Possible urethral rupture
Diagnosis
■ X-ray (AP)
inlet
outlet
Diagnosis

■ CT scan
■ MRI
CT scan
■ Used to identify fractures in three dimensions.
■ If used in contrast, ongoing bleeding can be detected.
■ Posterior elements such as the sacrum, posterior iliac and
sacroiliac joint can be seen.
■ The anterior part is seen with both the ilium fracture and the pubic
ramus, and fractures in the column and acetabulum can be seen.
■ MRI provides a picture of the ligament in the posterior pelvis. Ligament
disruption, avulsion, and fracture hematoma can be seen on MRI
Classification

■ Tile
■ Young AndBurgess
 Classification
■ Type A: Pelvic ring stable
– A1: fracture not involving the
ring (i.e., avulsions, iliac wing,
or crest fracture)
– A2: Stable minimally displaced
fracture of the pelvic ring
■ Type B: Pelvic ring rotationally
unstable, vertically stable
– B1: Open book
– B2: Lateral compression:
ipsilateral
– B3: Lateral compression,
contralateral or bucket handle
type injury
■ Type C: Pelvic ring rotationally and
vertically unstable
– C1: Unilateral: rotationally and
vertically unstable
– C2: Bilateral
– C3: Associated with acetabular
fracture
Classification
■ Lateral compression
type I
– Sacral fracture on
side of impact
■ Lateral compression
type II
– Iliac wing fracture
on side of impact
■ Lateral compression
type III
– Type I or II injury
on side of impact
with contralateral
open book (APC)
injury
Classification
■ Anterior-posterior
compression (APC)
type I
– Minor opening of
symphysis and SI
joint anteriorly
■ APC type II
– Opening anterior
SI
■ APC type III
– Complete
disruption of SI
joint
Classification

■ Vertical displacement
of hemipelvis with
symphysis diastasis
or rami fractures
anteriorly, iliac wing,
sacral fracture or
sacroiliac dislocation
posteriorly, usually
through the SI joint,
occasionally through
the iliac wing or
sacrum.
Management

■ Assessment and ATLS

■ Selection of operative method
■ Follow-up
Management
■ Pelvic sheet and wrap
– For stabilization purposes
– Prehospital management
– Pressure 180 Newtons
Management
■ External fixation
■ C-clamp
Management
Anterior injury reconstruction
Management
Posterior injury reconstruction
Thank You