PELVIC FRACTURES
Ass.Pr.Dr.Wahid M. Hassan
Anatomy
1.
The pelvis is composed anteriorly of the
ring of the pubic and ischial rami
connected with the symphysis pubis.
2. A fibro cartilaginous disc separates the
two pubic bodies.
3. Posteriorly, the sacrum and the two
innominate bones are joined at the sacroiliac
joint by the interosseous sacroiliac ligaments,
the anterior and posterior sacroiliac ligaments,
the sacrotuberous ligaments, the sacrospinous
ligaments, and the associated iliolumbar
ligaments.
4. This ligamentous complex provides stability to
the posterior sacroiliac complex, since the
sacroiliac joint itself has no inherent bony
stability.
Mechanism of injury
1.
anteroposterior compression
injuries,
2.
lateral compression injuries, or
3. vertical shear injuries
Classifications. ( Tile)
Type A. Stable
A 1. fractures of the pelvic not involving
the Ring.
A 2 . Stable , minimally displaced
fracture of the Ring .
Type B. Rotationally Unstable
Vertically Stable.
B1. Open Book
B2 . Lateral Compression :
Ipsilateral
B3. Lateral Compression
:Contra lateral

Type C. Rotationally and Vertically
Unstable
C1 . Unilateral
C2 . Bilateral
C3 . Associated with Acetabular
Fracture
Classifications
Anteroposterior compression (APC)
Lateral compression (LC)
injuries
Vertical shear (VS) injuries
Clinical findings
1.
2.
A history of high-energy injury
caused by motor vehicle or
motorcycle collisions or falls
from heights
Pelvic fractures are associated
with other injuries such as head,
chest, abdominal and
retroperitoneal vascular injuries
that may be life-threatening
physical examinations
(1) Appropriate measurement of leg-length
discrepancies and evaluation of internal
and external rotational abnormalities and
open wounds are important
(2) The evaluation of soft tissue injuries,
e.g.
contusions,
hemorrhage,
hematomas
(3) Rotational instability
can be assessed by pushing on the
anterosuperior iliac wings both
internally and externally to
determine whether the pelvis opens
and closes. Pull-push evaluation of
the leg can be used to determine
any vertical migration of the pelvis
Roentgenographic evaluation
1.
2.
an anteroposterior view of the
pelvis and the 40-degree caudal
inlet and 40-degree cephalad
outlet views
Computed tomography is an
essential part of the evaluation of
any significant pelvic injury
A, Forty-degree
caudal inlet view of
pelvis
B, Forty-degree
cephalad outlet view
of pelvis
A, Tile type B1
pelvic injury with
diastases of
symphysis and
anterior widening
of sacroiliac joint.
B, CT scan shows
that posterior
sacroiliac joint
ligaments are
intact
Treatment
1) Priority should be given to the
treatment of airway, breathing, and
circulation problems
2)
For
mildly
displaced
lateral
compression injuries, bed rest usually
is sufficient
3) Operative reduction and internal
fixation of pelvic fractures traditionally
have been delayed for a few days to
allow evaluation and treatment of lifethreatening
injuries,
preoperative
planning, and assembly of necessary
equipment
Anterior plating of sacroiliac joint
Complications
1) retroperitoneal vascular injuries
2) major visceral injuries: liver,
kidney, or spleen and intestines
3) bladder and urethra injuries
4) rectal injuries
5) nerve injuries: lumbosacral
plexus and sciatic nerve