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Chapter: Orthopaedics

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Pelvic Fracture

Pelvic Fracture
young: high energy trauma, either direct or by force transmitted longitudinally through the femur

Pelvis

 

Pelvic Fracture

 

Mechanism

·                 young: high energy trauma, either direct or by force transmitted longitudinally through the femur

·                 elderly: fall from standing height. low energy trauma

 

Clinical Features

·                 local swelling. tenderness

·                 deformity oflower extremity

·                 pelvic instability

 

Investigations

·                 x-ray: AP pelvis, inlet and outlet for pelvic fracture

o       Judet films (obturator and iliac oblique) for acetabular fracture

o       6 cardinal radiographic Unes of the acetabulum: ilioischial line, iliopectlneal line, tear drop. roof, posterior rim. anterior rim

·                 CT scan useful for evaluating posterior pelvic injury and acetabular fracture

 

Table 4. Tile Classification of Pelvic Fractures (see Figure 11)


 

Type: Stability Description

 

A Rotationally stable Vertically stable

A1: fracture not involving pelvic ring

A2: minimally displaced fracture of pelvic ring {e.g. ramus fracture)

 

B Rotationally unstable Vertically stable

B1 : open book

B2: lateral compression- ipsilateral

B3: lateral compression- contralateral

 

c Rotationally unstable

C1: unilateral Vertically unstable

C2: bilateral

C3: associated acetabular fracture

 

Treatment

·                 ABCs

·                 assess genitourinary injury (rectal exam, vaginal exam, hematuria, blood at urethral meatus)

o       if involved, the fracture is considered an open fracture

·                 stable fractures - nonoperative treatment, protected weight bearing

·                 indications for operative treatment

o       unstable pelvic ring injury

o       disruption of anterior and posterior SI ligament

o       symphysis diastasis >2.5 cm

o       vertical instability of the posterior pelvis

 

Specific Complications (see General Fracture Complications)

·                 hemorrhage (life-threatening) - 1500-3000 ml blood loss

·                 injury to rectum or urogenital structures

·                 obstetrical difficulties

·                 persistent sacroiliac (SI) joint pain

·                 post-traumatic arthritis of the hip with acetabular fractures

·                 high risk of DVT/PE

 

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