acetabular and hip fracture

7/23/2019 Acetabular and Hip Fracture

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HIP AND ACETABULUM

FRACTURE


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HIP ANATOMY

AMALESHWAREE

012011100118


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ANATOMY OF THE HIP


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Hip bones

Flat bone! "o#$ bon% &el'( alon) *(t+a,#-$ an. ,o,,%/

Pote#(o#l% a#t(,-late *(t+ t+e a,#-$ at

t+e a,#o(l(a, o(nt Ante#(o#l% a#t(,-late *(t+ ea,+ ot+e# at a

o(nt ,alle. &-b(, %$&+%e

Conta(n &a#t &-b(! (l(-$ an.(,+(-$


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Bony pelvis

- formed by sacrum, coccyx and pair of hip bones

coccyx

sacrumHip bone

Pubic symphysis

Obturator

foramen

Acetabulum


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Hip bone lateral view

Ante#(o# -&e#(o#

(l(a, &(ne

Ante#(o# (n"e#(o#

(l(a, &(nePote#(o# (n"e#(o#

(l(a, &(ne

Pote#(o# -&e#(o#

(l(a, &(ne

T-be#o(t% o"

(l(a, ,#etIl(a, ,#et

3#eate# ,(at(,

not,+

Lee# ,(at(,

not,+

I,+(al &(ne

I,+(al t-be#o(t%

Obt-#ato# "o#a$en

A,etab-l-$

Posterior Anterior


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Hip bone medial view

Ante#(o# -&e#(o#

(l(a, &(ne

Ante#(o# (n"e#(o#

(l(a, &(ne

A-#(,-la# -#"a,e

4a#t(,-late *(t+

Sa,#-$ to "o#$Sa,#o(l(a, o(nt5

AnteriorPosterior


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Hip joint

Hip

bone


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Hip oint

T%&e6 S%no'(al o(nt S-bt%&e6 Ball an. o,7et

Articular surfaces!

Hea. o" "e$-# an. a,etab-l-$ o" +(&bone

Head of femur!

Fo#$ t*o t+(#. o" a &+e#e I ,o'e#e. b% t+e a#t(,-la# ,a#t(la)e e/,e&t

at t+e "o'ea ,a&(t(


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"ovea capitis

#Pit for li$ament of head of femur%

Acetabular

mar$in

Acetabular

notch

&unatesurface

Acetabular

"ossa

Head of femur

Acetabulum Head of femur


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Acetabulum! He$(&+e#(,al +ollo* on t+e late#al -#"a,e o" +(& bone It ( l($(te. b% t+e a,etab-la# $a#)(n

A,etab-l-$ +a t*o &a#t l-nate -#"a,e an. a,etab-la#"oaa

&unate surface!C +a&e. a#t(,-la# a#ea ,o'e#e. b% t+e+%al(ne ,a#t(la)e

Acetabular fossa!Dee& nona#t(,-la# &a#t "(lle. *(t+a,etab-la# &a. o" "at

A,etab-la# $a#)(n ( abent on t+e (n"e#(o# a&e,t! +e#e (t (

#e&la,e. b% t+e a,etab-la# not,+


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Acetabular labrum! F(b#o,a#t(la)(no- #(n) atta,+e. to t+e

$a#)(n o" a,etab-l-$ In,#eae t+e .e&t+ o" a,etab-l-$ Re&la,e. (n"e#(o#l% at t+e a,etab-la# not,+

b% t+e t#an'e#e a,etab-la# l()a$ent


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&i$aments of the hip joint

19 Il(o"e$o#al l()a$ent 4 o" B()elo*5

29 P-bo"e$o#al l()a$ent

9 I,+(o"e$o#al l()a$ent:9 T#an'e#e a,etab-la# l()a$ent

;9 L()a$ent o" +ea. o" "e$-#


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L-nate -#"a,e

T#an'e#e a,etab-la#

l()a$ent

L()a$ent o" +ea. o" "e$-#

A,etab-la# "oa

A,etab-la# lab#-$

F(b#o- ,a&-le


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A,etab-la# "oa

*(t+ a,etab-la#

&a. o" "at

L-nate -#"a,e l(ne.

b% +%al(ne ,a#t(la)e

L()a$ent o" +ea.o" "e$-#

T#an'e#e

A,etab-la#

L()a$ent


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"ibrous capsule!

S-##o-n. t+e o(nt

It (nne# -#"a,e ( l(ne. b% t+e %no'(al$e$b#ane

'edial attachment! to t+e +(& bone

Atta,+e. to t+e a,etab-la# $a#)(n an.t#an'e#e a,etab-la# l()a$ent

&ateral attachment!to ne,7 t+e "e$-#

Ante#(o#l% to t+e (nte#t#o,+ante#(, l(ne Pote#(o#l% to t+e &ote#(o# -#"a,e o" ne,7

o" "e$-#! -t $e.(al to (nte#t#o,+ante#(,,#et


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Ca&-le ,onta(n o-te# lon)(t-.(nal "(b#e an.

(nne# ,(#,-la# "(b#e 4


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Bloo. -&&l% o" t+e +(& o(nt


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Relat(on o" t+e +(& o(nt


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F#a,t-#e o" t+e &el'(


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F#a,t-#e o" t+e &el'(

+o-l. be -&e,te. (n e'e#% &at(ent *(t+ e#(o- ab.o$(nal

o# lo*e# l($b (n-#(e

+(to#% o" a #oa. a,,(.ent o# a "all "#o$ a +e()+t o# ,#-+(n-#%9

O"ten t+e &at(ent ,o$&la(n o" e'e#e &a(n an. "eel a (" +e

+a "allen a&a#t! an. t+e#e $a% be *ell(n) o# b#-((n) o" t+e

lo*e# ab.o$en! t+e t+()+! t+e &e#(ne-$! t+e ,#ot-$ o# t+e

'-l'a9


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t+e "(#t (o#(t%! al*a%! ( to ae t+e &at(ent? )ene#al ,on.(t(onan. loo7 "o# ()n o" bloo. lo9 It $a% be ne,ea#% to ta#t

#e-,(tat(on be"o#e t+e e/a$(nat(on ( ,o$&lete.9

T+e ab.o$en +o-l. be ,a#e"-ll% &al&ate.9 S()n o" (##(tat(on-))et t+e &o(b(l(t% o" (nt#a&e#(toneal blee.(n)9

Ten.e#ne o'e# t+e a,#o(l(a, #e)(on ( &a#t(,-la#l% ($&o#tant an.

$a% ()n("% .(#-&t(on o" t+e &ote#(o# b#(.)e9


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Re,tal e/a$(nat(on

,a##(e. o-t (n e'e#% ,ae9

T+e ,o,,%/ an. a,#-$ ,an be "elt an. tete. "o# ten.e#ne9

I" t+e otate ,an be "elt! *+(,+ ( o"ten .(""(,-lt .-e to &a(n

an. *ell(n)! (t &o(t(on +o-l. be )a-)e.@ an abno#$all%

+()+ otate -))et a -#et+#al (n-#%9


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En-(#e *+en t+e &at(ent &ae. -#(ne lat an. loo7 "o#

blee.(n) at t+e e/te#nal $eat-9

An (nab(l(t% to 'o(. an. bloo. at t+e e/te#nal $eat- a#e t+e

,la(, "eat-#e o" a #-&t-#e. -#et+#a9


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T+e &at(ent ,an be en,o-#a)e. to 'o(.@ (" +e ( able to .o o!

e(t+e# t+e -#et+#a ( (nta,t o# t+e#e ( onl% $(n($al .a$a)e*+(,+ *(ll not be $a.e *o#e b% t+e &aa)e o" -#(ne9

No atte$&t +o-l. be $a.e to &a a ,at+ete#! a t+( ,o-l.

,on'e#t a &a#t(al to a ,o$&lete tea# o" t+e -#et+#a9

I" t+e -#et+#al (n-#% ( -&e,te.! t+( ,an be .(a)noe.$o#e a,,-#atel% an. $o#e a"el% b% #et#o)#a.e

-#et+#o)#a&+%9


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A #-&t-#e. bla..e# +o-l. be -&e,te. (n &at(ent *+o .o

not 'o(. o# (n *+o$ a bla..e# ( not &al&able a"te# a.e-ate

"l-(. #e&la,e$ent9

t+e &+%(,al "(n.(n) (n(t(all% ,an be $(n($al! *(t+ no#$al

bo*el o-n.! a e/t#a'aat(on o" te#(le -#(ne o.-,e l(ttle

&e#(toneal (##(tat(on9


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Ne-#olo)(,al e/a$(nat(on ( ($&o#tant@ t+e#e $a% be .a$a)e

to t+e l-$ba# o# a,#al &le/-9

If the patient is unconscious, the same routine isfollowed. However, early x-ray examination is

essential in these cases.


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A()*AB+&A "A(*+)

B-ane*a#an Ma)en.a#an

012011100010


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Me,+an($ o" In-#%

Occurs when head of femuris driveninto the pelvis, 2 mechanisms involved:

Fall from heiht !"low on the side#

$ %ash"oard in&ury !"low on the front ofthe 'nee


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Patte#n o" F#a,t-#e

- De&en. on t+e 6

Position of the femoral head at the

time of injury Hip externally rotated and abducted

( anterior column injury)

'a$nitude of force

A$e of patient


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Cla("(,at(on o" F#a,t-#e

udet &etournel (lassification . elementary fracture types

. associate fracture types


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Cla("(,at(on o" F#a,t-#e

( main elements:

)ceta"ular wall fractures !ant orpost#

$ )nterior column fractures

* +osterior column fractures

ransverse fractures


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T%&e o" F#a,t-#e

Acetabular wall fractures (ant orpost)

a/ects the depthof the soc'et

leads to hip insta"ility unlessproperly reduced

and 0xed

+ost wall fracture is the commonest

!dash"oard in&ury#


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T%&e o" F#a,t-#e

Anterior column fractures 1uns throuh anteriorpart of

aceta"ulum, separatin a sement

"etween anterior inferior iliacspine obturator foramen

%oes not involve weiht"earin area

3ood pronosis 4ncommon


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T%&e o" F#a,t-#e

Posterior column fractures 1uns upwards from the obturator

foramen into the sciatic notch

5eparates posterior ischiopu"ic columnof "one "rea'intheweiht-"earinpart of aceta"ulum

)ssociated with posterior dislocation

of hip may injure sciatic nervereatment is more urent


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T%&e o" F#a,t-#e

Transverse fractures 4ncomminuted fractures

1uns transversely through

acetabulum, separates iliacportiona"ove from pubic & ischialportions"elow

6ay "e associated with sacroiliac&oint in&ury


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T%&e o" F#a,t-#e

Associated fracturesA#e ,o$b(nat(on o" ele$ental "#a,t-#e

A#t(,-la# -#"a,e a#e $o#e e'e#el%

.(#-&te.


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Ao,(ate. F#a,t-#e

*ype / - Posterior (olumn 0 Posterior

1all

*ype 2 - *ransverse 0 Posterior wall

*ype 3 - *-shape fracture

*ype 4 - Anterior (olumn 0 Posterior

hemitransverse

*ype . - Both column fractures


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Ao,(ate. F#a,t-#e


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(linical "eaturesC+e#n(+a a& Elan C+el(%an

0120111001


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Cl(n(,al Feat-#e

- Severe injury !tra7c accident8fall from heiht#

- Associated fractures

9 any case of fractured femur, calcaneum or

severe 'nee in&ury- Severe shoc

- Sin ! local wounds, a"rasion, "ruisin

- Attitude of the limb - lyin in internal rotation

!if hip dislocated#- "eurovascular assessment !5ciatic nervepalsy #


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I$a)(n)

#) Plain $-%ay Pelvis

)+ view : cardinal lines of pelvis

O"turator o"li;ue view

Iliac o"li;ue view

2#


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#a% 4AP '(e*5 Sta#t e'al-at(on *(t+ t+( '(e*


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#a% 4Obt-#ato# Obl(-e5

:;o(nte#nal #otat(on

'(e*

Bet .e$ont#ate t+e

ante#(o# ,ol-$n 4(l(o

&e,t(neal l(ne5an. t+e

&ote#(o# *all9


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Obturator Oblique View radiograph

19 Pel'(, b#($ o# Il(o&e,t(n(al 4Il(o&-b(,5 l(ne a)a(n! #eeent t+e ante#(o# ,ol-$n

29 Ante#(o# l(& o" a,etab-l-$ #eeent t+e ante#(o# *all o" t+e a,etab-l-$

9 Pote#(o# l(& o" a,etab-l-$ #eeent t+e &ote#(o# *all o" t+e a,etab-l-$


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#a% 4Il(a, Obl(-e5

:;oe/te#nal #otat(on

'(e*9

Bet .e$ont#ate

&ote#(o# ,ol-$n 4(l(o(+,(al l(ne5 an.

ante#(o# *all9


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Iliac Oblique View radiograph

19 Il(o(,+(al l(ne t+( l(ne #eeent t+e &ote#(o# ,ol-$n

29 Ante#(o# l(& o" a,etab-l-$ #eeent t+e ante#(o# *all o" t+e a,etab-l-$

9 Pote#(o# l(& o" a,etab-l-$ #eeent t+e &ote#(o# *all o" t+e

a,etab-l-$


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Pote#(o# *all a,etab-la#"#a,t-#e9 Ante#o&ote#(o#

#a.(o)#a&+ o" t+e &el'(9 T+e

&ote#(o# *all o" t+e le"t

a,etab-l-$ ( .(#-&te. 4a##o*59

Pote#(o# *all a,etab-la#"#a,t-#e9 A le"t obt-#ato# obl(-e

#a.(o)#a&+ o" t+e &el'(9 T+e

&ote#(o# *all "#a,t-#e 4a##o*5 (

bette# .e&(,te. on t+( '(e*

t+an on t+e ante#o&ote#(o#

'(e*9


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CT S,an

P#o'(.e a..(t(onal (n"o#$at(on

(


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Co$&-te. to$o)#a&+% 4CT5 ,an o" a &ote#(o# *all a,etab-la#

"#a,t-#e9 T+e obl(-e "#a,t-#e o" t+e le"t a,etab-l-$ ( ,lea#l%

.e&(,te.9 T+e .e)#ee o" .(&la,e$ent an. $a#)(nal ($&a,t(on ,an be

.ete#$(ne. $o#e a,,-#atel% *(t+ CT ,ann(n) t+an *(t+ #a.(o)#a&+%9


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*reatment

(hristina a5p ayaraj Paul

6/26///66/34


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'ana$ement

3oal o" t#eat$ent T+e )oal o" t#eat$ent ( anato$(, #eto#at(on o"

t+e a#t(,-la# -#"a,e to e'ent &ott#a-$at(,

a#t+#(t(9 In(t(al $ana)e$ent

T+e &at(ent ( --all% &la,e. (n 7eletal t#a,t(on

to 19 allo* "o# (n(t(al o"t t(-e +eal(n)!

29 allo* ao,(ate. (n-#(e to be a..#ee.!

9 $a(nta(n l($b len)t+!

:9 $a(nta(n "e$o#al +ea. #e.-,t(on *(t+(n t+e

a,etab-l-$9


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De"(n(t('e t#eat$ent 6

2; .a% &ot (n-#%

.ela% +o-l. not e/,ee. > .a%


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)mer$ency *reatment

P#(o#(t% ,o-nte#a,t +o,7 an. #e.-,e

a

.(lo,at(on9

15 S7eletal t#a,t(on a&&l(e. to .(tal "e$-#

4107) *(ll -""(,e5

25 Ne/t : .a%! &at(ent )ene#al ,on.(t(on

( b#o-)+t -n.e# ,ont#ol9


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*reatment Option

7on operative

Operative


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7on- operative treatment

Abol-te ,ont#a(n.(,at(on

Lo,al o# %te$(, (n"e,t(on

Se'e#e oteo&o#oe

Relat('e ,ont#a(n.(,at(on

A.'an,e. a)e

Ao,(ate. $e.(,al ,on.(t(on

Ao,(ate. o"t t(-e an. '(,e#al (n-#(e M-lt(&le (n-#e. &at(ent not table "o# a b()

a,etab-la# -#)e#%


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7on-operative

P#ote,te. *e()+t bea#(n) "o# 8 *ee7

- Lon)(t-.(nal t#a,t(on! (" ne,ea#%!

-&&le$ente. b% late#al t#a,t(on

- H(& $o'e$ent an. e/e#,(e a#e

en,o-#a)e.

- Pat(ent t+en allo*e. -&! -(n) ,#-t,+e

*(t+ $(n($al *e()+t bea#(n) "o# a "-#t+e# *ee7

,loe $on(to#(n


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In.(,at(on

M(n($al .(&la,e$ent o" "#a,t-#e G$$

Le t+an 20 &ote#(o# *all "#a,t-#e

Fe$o#al +ea. #e$a(n ,on)#-ent *(t+ *e()+t

bea#(n) #oo" 4 o-t o" t#a,t(on5


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Bot+ ,ol-$n "#a,t-#e

F#a,t-#e (n el.e#l% *+e#e ,loe.

#e.-,t(on ee$ "ea(ble

Me.(,al ,on.(t(on to o&e#at('e t#eat$ent

4 (n,l-.(n) lo,al e&(5

C#(te#(a b% Matta an. Me##(tt (" ,one#'at('e


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%

t#eat$ent ( -,ee.e. 6

15 W+en t#a,t(on ( #eleae.! +(& +o-l.

#e$a(n ,on)#-ent

25 We()+tbea#(n) &o#t(on o" t+e a,etab-la#

#oo" +o-l. be (nta,t

5 Ao,(ate. "#a,t-#e o" t+e &ote#(o# *all

+o-. be e/,l-.e. b% CT ,an9


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Operative

H(& $a% be .(lo,ate. 6

,ent#all%! ante#(o#l% an. &ote#(o#l%

Open reduction internal

fixation


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O&en #e.-,t(on (nte#nal "(/at(on

8ndication6

D(&la,e$ent o" #oo" $$

Pote#(o# *all "#a,t-#e (n'ol'(n) :0 ;0

Ma#)(nal ($&a,t(on

I##e.-,(ble "#a,t-#e .(lo,at(on

A&oa,+e


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A&oa,+e 9ocher-&an$enbec:4Pote#(o#56 bet a,,e to

&ote#(o# *all an. ,ol-$n 4one5

8lioin$uinal4Ante#(o#56 bet a,,e to ante#(o# *all an.,ol-$n "#a,t-#e

an. (nne# a&e,t o" (nno$(nate bone 4-&(ne5

)xtended iliofemoral 4Late#al56 bet ($-ltaneo- a,,eto t+e t*o ,ol-$n 4late#al5

~No single approach provides ideal exposure of all

fracture types.

~Proper preoperative classification of the fracture

configuration is essential to selecting the best surgical approach


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Jo,+e#Lan)enbe,7 A&oa,+

8ndications


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8ndications

Pote#(o# *all "#a,t-#e

Pote#(o# ,ol-$n "#a,t-#e

Pote#(o# ,ol-$n&ote#(o# *all "#a,t-#e

So$e Tt%&e "#a,t-#e

A#ea a,,e(ble b% Jo,+e# Lan)enbe,7


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A#ea a,,e(ble b% Jo,+e#Lan)enbe,7

a&oa,+


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Il(o(n)-(nal a&oa,+


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8ndications

Ante#(o# *all an.

Ante#(o# ,ol-$n

T#an'e#e *(t+ ()n("(,ant ante#(o#

.(&la,e$ent

Bot+,ol-$n "#a,t-#e


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E/ten.e. (l(o"e$o#al a&oa,+


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8ndications

T#an'e#e "#a,t-#e *(t+ e/ten.e. &ote#(o# *all

T+a&e. "#a,t-#e *(t+ *(.e e&a#at(on o" t+e 'e#t(,al

te$ o" t+e KT? o# t+oe *(t+ ao,(ate. &-b(, %$&+%(.(lo,at(on

Ce#ta(n ao,(ate. bot+ ,ol-$n "#a,t-#e

Ao,(ate. "#a,t-#e &atte#n o# t#an'e#e "#a,t-#e

o&e#ate. on 21 .a% "ollo*(n) (n-#%


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)xtended iliofemoral approach+a t+e

+()+et (n,(.en,e o"

e,to&(, bone "o#$at(on 4HO5

an.

lon)et &oto&e#at('e #e,o'e#%

Ot+e# a&oa,+e


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Ot+e# a&oa,+e

Sto&&a a&oa,+ 4-&(ne56 Allo* a,,e

to t+e $e.(al *all o" a,etab-l-$!

-a.#(late#al -#"a,e! a,#o(l(a, o(nt

T#(#a.(ate a&oa,+ 4one56 Alte#natee/&o-#e to t+e e/te#nal a&e,t o"

(nno$(nate bone! *(t+ al$ot a$e

e/&o-#e a (l(o"e$o#al b-t '(-al(


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T+e "#a,t-#e4"#a,t-#e5 ( "(/e. *(t+ la)

,#e*e o# &e,(al b-tt#e(n) &late*+(,+ ,an be +a&e. (n t+e OT9

9


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Pat(ent *(t+ isolated posterior wall

"#a,t-#e an. .(lo,at(on $a% #e-(#e

($$e.(ate o&en #e.-,t(on an.tab(l(


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P#o&+%la,t(, ant(b(ot(, a#e -e.

In.o$et+a,(n)('en o&+%la/( a)a(nt+ete#oto&(, o("(,at(on

Poto&e#at('e +(& $o'e$ent ta#te. a

a oon a &o(ble Pat(ent allo*e. -&! &a#t(al *e()+tbea#(n)

*(t+ ,#-t,+e! a"te# > .a%

E/e#,(e ,ont(n-e. "o# $ont+

Operative treatment contraindication


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Operative treatment contraindication

Abol-te ,ont#a(n.(,at(on Lo,al o# %te$(, (n"e,t(on

Se'e#e oteo&o#oe

Relat('e ,ont#a(n.(,at(onA.'an,e. a)e

Ao,(ate. $e.(,al ,on.(t(on

Ao,(ate. o"t t(-e an. '(,e#al (n-#(e M-lt(&le (n-#e. &at(ent not table "o# a b()

a,etab-la# -#)e#%


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;ur$ical emer$encies (n,l-.e6 O&en a,etab-la# "#a,t-#e

Ne*onet ,(at(, ne#'e &al% a"te# ,loe.

#e.-,t(on o" +(& .(lo,at(on

I##e.-,(ble &ote#(o# +(& .(lo,at(on

C l( t(


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Co$&l(,at(on

S-#)(,al *o-n. (n"e,t(on6 R(7 ( (n,#eae.e,on.a#% to t+e een,e o" ao,(ate.ab.o$(nal an. &el'(, '(,e#al (n-#(e9

Ne#'e (n-#%

S,(at(, ne#'e6Jo,+e#Lan)enba,+ a&oa,+*(t+ olon)e. o# "o#,e"-l t#a,t(on9 Fe$o#al ne#'e6Il(o(n)-(nal a&oa,+ $a% #e-lt

(n t#a,t(on (n-#% to "e$o#al ne#'e9 Ra#el%! t+ene#'e $a% be la,e#ate. b% an ante#(o# ,ol-$n

"#a,t-#e9


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A'a,-la# ne,#o(6 T+( .e'atat(n),o$&l(,at(on o,,-# $otl% *(t+ &ote#(o#

t%&e ao,(ate. *(t+ +()+ene#)% (n-#(e9

Oteoa#t+#(t(

Hete#oto&(, bone "o#$at(on


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Pel'(,

F#a,t-#e-an(ta a& Hen#%

0120111001;=

T " " t


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T%&e o" "#a,t-#e

Pel'( "#a,t-#eIolate. "#a,t-#e *(t+ an (nta,t &el'(, #(n)

I l t . F t


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Iolate. F#a,t-#e

Iolate. F#a,t-#eA'-l(on "#a,t-#e

A l ( F t


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A'-l(on F#a,t-#e

A &(e,e o" bone ( &-lle. o"" b% '(olent$-,le ,ont#a,t(on9

Seen (n &o#t &a#t(,(&ant an. at+lete9

T/6 Ret "o# "e* .a% an. #ea-#an,e9


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Avulsion Anterior


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8nferior

8liac ;pine #A88;%

Avulsion 8schial *uberosity


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Avulsion 8schial *uberosity

D(#e,t "#a,t-#e


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D(#e,t "#a,t-#e

A .(#e,t blo* to t+e &el'(

Fall "#o$ a +e()+t

F#a,t-#e (,+(-$ o# (ll(a, bla.e

T/6 be. #et -nt(l &a(n -b(.e9

F#a,t-#e at t+e #()+t (ll(-$


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F#a,t-#e at t+e #()+t (ll(-$

St#e "#a,t-#e


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St#e "#a,t-#e

Se'e#el% oteo&o#ot(, o# oteo$ala,(,&at(ent9

F#a,t-#e o" t+e &-b(, #a$( 4,o$$on

&a(nle5

F#a,t-#e at t+e &-b(, #a$( an. &-b(,


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& &

t-be#,le (n an oteo&o#ot(, &at(ent


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ractures of pelvic ring

( mechanism of injury)

Tile classi'cation


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): sta"le = - rotationally unsta"le,vertically sta"le

< - rotationally andvertically unsta"le

)>: fracture not involvin therin !avulsion or iliac winfracture#

=>: open "oo' in&ury!external rotation#

: unilateral

)2: sta"le or minimally displacedfracture of the rin

=2: lateralcompression in&ury!internal rotation#


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5een in 6A)s +u"ic symphysis disrupted, continue

to posterior 5IB C open "oo' in&ury D Increase pelvic volume 6ay "e torn 5I liaments, fracture

post. Ilium, vertical sacral fracture

compression

ateral compression


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5ide to sidecompression of pelvicrin

5ide impact inaccidents )nteriorly, pu"ic rami

fractured ! one8"oth#, +osteriorly 5I

strain8fracture If displaced, "ecomes

unsta"le

ateral compression


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*ombination injuries


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*+"+*A ,AT%,S+1E5HEE) G46)1)>2>J>2(


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+S.AT,/ %A*T%,S and STA0, +"1%+,S ot severely shoc'ed +ain on attempt to wal' ocali@ed tenderness "ut seldom damae of

the pelvic viscera


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"STA0, +"1%+,S 5everely shoc'ed +ain and una"le to stand 4na"le to pass urine

=lood loss the external meatus enderness )ttempt to move the ilium will "e painful Foot drop due to ( in&ury

+artial num"ness of one side of the le due tosciatic nerve

Hih ris' of visceral damae


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Its only the mechanically unsta"le fractureled to hamodynamic insta"ility

If patient has sta"le pelvic fracture "uthemodynamically unsta"le, loo' for other

source of "leedin e. chest or a"domen


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.P," P,+* %A*T%, 5evere "lood loss Klo rollL patient to ensure there is no

external "lood loss.


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T%,AT2,"T . 3+P

%A*T%,5H)3EEH) )3)1)B)O>2>>(MN2

P,+* %A*T%,S


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P,+* %A*T%,S

Late#al

Co$e(o

n 4LC5

Ante#o&ote#(o#

Co$e(on

4APC5

e#t(,al S+ea#

4S5

AT,%A *.2P%,SS+."


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AT,%A *.2P%,SS+."

A"T,%.P.ST,%+.%


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*.2P%,SS+."

AT,%A *.2P%,SS+."


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AT,%A *.2P%,SS+."

4ndisplaced rin fracture ateral compression involvin pu"ic ramus

fracture anteriorlyand undisplaced sacralfracture posteriorly

+ain usually su"sides after a few days N w's "ed rest com"ined with traction )llow usin crutchesfor another few wee's


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A"T,%.P.ST,%+.%*.2P%,SS+."


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*.2P%,SS+."

Ant disruption without sacroiliacdisplacement Open "oo' in&ury !ap of 2cm#: "ed rest a"out

wee', with post slin or elastic irdle to help

to close the "oo' IF P 2 cm, severe in&ury: External 0xation !Q->2wee's#

-pu"ic ramus fracture: "ed rest

-if the patient need laparotomy,so openreduction and internal 0xation "y plates

and screws or "y G. wire.

Displaced with sacroiliac disruption


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Displaced with sacroiliac disruption

2 techni;ues are used to sta"ili@e

-anterior external 0xation and posteriorsta"ili@ation usin screw across the s8i &oint

-platin the symphysis anteriorly and screwacross the s8i &oint posteriorly

,%T+*A S3,,% A"/ /+SPA*,/AT,%A *.2P%,SS+." %A*T%,


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AT,%A *.2P%,SS+." %A*T%,

Fracture must "e reduced and sta"ili@ed +osteriorly, reduction is done "y traction or

illiosacral screw 0xation, open reductionand internal 0xation

)nteriorly, open reduction and internal0xator of the symphysis or external 0xator


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,A%4 2A"A5,2,"T

. 3+P %A*T%,5)I5H G46)1>2>>>>QM

,A%4 ST,PS


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,A%4 ST,PS

1esuscitation !advanced trauma life support# Ro rollR patient to ensure no external "lood lossposteriorly.

Intesive resuscitation as "leedin may "edramatic.

Find out mechanism of in&ury !hih8low enery# )ny patient with a suspected pelvic fracture

should have a pelvic compression "inder applieddurin >st aid in order to provide immediate

sta"ility. 1outine chest x-ray to loo' for any haemothorax!treat with drain#

F)5 scan to exclude intraperitoneal hemorrhae

If Suid is found in a"domen, it should "e exploredvia laparotomy !attempt to 0nd and deal with


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via laparotomy !attempt to 0nd and deal withsource of haemorrhae#

Examination to exclude intraa"dominal in&ury andneuroloical de0cit. )ssess the sta"ility of pelvis

-rotationalT 0rmly rip "oth iliac crests

to s;uee@e them toether

and push them apart.

-vertical T 2 people, one holds "oth

iliac crests to detect

movement, other applies

lonitudinal traction and compthrouh les.


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+atient who cannot pass urine must O "ecatheteri@ed, consider suprapu"iccatheteri@ation or cystotomy. 1etroradeurethroram useful to show urethral tear.

U-ray of pelvis : ideally ( views, )+

mandatory, Inlet, outlet, 2 o"li;ue views.

0,,/+"5


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0,,/+"5

+elvic +ac'in if uncertain of source durin >st aid. )ressive Suid resuscitation is critical in thepatient who is hemodynamically unsta"le. heseverity of "lood loss can "e determined "yassessin the pulse, "lood pressure, and capillaryre0ll. hese indicators can "e used to evaluate a

patientVs response to the resuscitative e/ort. wolare-"ore !>-aue# intravenous catheters should"e placed.

1eplacement volume is estimated "y usin the

formula of ? mm of crystalloid for each > mm of"lood loss. ) minimum of 2 of crystalloid solutionis iven over 2 minutes, or more rapidly if thepatient is in shoc'.

6ost incidents of "lood loss from a pelvicin&ury arise from cancellous "one at the


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in&ury arise from cancellous "one at thefracture site or from a retroperitoneal lum"ar

plexus venous in&ury. Only 2W of deathsfrom pelvic hemorrhae are attri"uted to ama&or arterial in&ury. +osterior arterial"leedin is more common in patients with

unsta"le posterior pelvic fractures, andanterior arterial "leedin !pudendal oro"turator# is more common in patients withlateral compression !


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!%+# can "e used as a ;uic' and accuratedianostic tool.


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=y :

Ainavinashini

6ahaeswarren

(omplications of

Pelvic "racture

*omplications of Pelvic t


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ractureHe$o##+a)e an. S+o,7

#6 3emorrhage and Shoc


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g 5een in a serious pelvic in&ury, especially an

open pelvic fracture.

Hemorrhae, either intraperitoneal orretroperitoneal.

Intraperitoneal hemorrhae is "est manaed "y directsurical intervention at laparotomy.

Intrapelvic retroperitoneal hemorrhae is "est manaed"y rapid and continuin "lood replacement and "yimmediate external sta"ili@ation of the pelvic fractures.

76 rogenital damage


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g g )+< are the common causeXX 5ymphyseal widenin is associated with

urethal in&ury %isplaced rami fractures may cause "ladder

in&ury 4rinary drainae "y suprapu"ic cystostomy

ate complications include :-

4rethral stricture

Incontinence

Impotence

86 0owel injury


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j y%efunctionin colostomy

!not to contaminated the pelvis# ) re-anastomosis is performed at ->2

months once healin has occurred.

N. Aainal in&ury%isplaced pu"ic ramus fractures can tear

the lateral wall of the vaina

Yashed out and repaired(. Infection

96 "erve injury


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j y %isplacement of the sacroiliac &oint or

fracture of the sacrum may in&ure thelum"osacral plexus !(9 nerve root#.

M. +ersistent sacroiliac pain Occurs when the 5IB in&ury has "een left

untreated.Fusion if symptoms are severe.

:6 enous thromboembolicdisease


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disease Especially when they undero operative 0xation

XX+rophylaxis is initiated at dianosis, and continuedfor ->2 wee's.

J. 6alunion of the fracture6ay result in an a"normal ait, di7culty sittin,and "ac' pain.

) deformed pelvis can interfere with future

vainal deliveries and necessitate a


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1EFE1E


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acetabular and hip fracture

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