Deformity of the Pelvis

Charles A Simanjuntak, dr, SpOT(K), MPd

FKIK Universitas Jambi
Type of pelvis(1)
• Android pelvis one with a wedge-
shaped inlet and narrow anterior
segment typically found in the male.
• Anthropoid pelvis one whose
anteroposterior diameter equals or
exceeds the transverse diameter.

CharlieASjuntak, FKIK-Jam 2
Type of pelvis(2)
• Assimilation pelvis one in which the
ilia articulate with the vertebral column
higher (high assimilation pelvis) or
lower (low assimilation pelvis) than
normal, the number of lumbar vertebrae
being correspondingly decreased or
increased.

CharlieASjuntak, FKIK-Jam 3
Type of pelvis(3)
• Beaked pelvis one with the pelvic
bones laterally compressed and their
anterior junction pushed forward.
• Brachypellic pelvis a short oval type of
pelvis, in which the transverse diameter
exceeds the anteroposterior diameter by
1 to 3 cm.

CharlieASjuntak, FKIK-Jam 4
Type of pelvis(4)
• Contracted pelvis one showing a
decrease of 1.5 to 2 cm in an important
diameter; when all dimensions are
proportionately diminished, it is a
generally contracted pelvis.
• Cordate pelvis a heart-shaped pelvis.

CharlieASjuntak, FKIK-Jam 5
Type of pelvis(5)
• Dolichopellic pelvis a long, oval
pelvis with the anteroposterior
diameter greater than the transverse
diameter.
• Flat pelvis one in which the
anteroposterior dimension is
abnormally reduced.

CharlieASjuntak, FKIK-Jam 6
Type of pelvis(6)
• Frozen pelvis a condition, due to
infection or carcinoma, in which the
adnexa and uterus are fixed in the
pelvis.
• Funnel pelvis one with a normal inlet
but a greatly narrowed outlet

CharlieASjuntak, FKIK-Jam 7
CharlieASjuntak, FKIK-Jam 8
Type of pelvis(7)
• Gynecoid pelvis the normal female
pelvis: a rounded oval pelvis with well
rounded anterior and posterior
segments.
• Infantile pelvis a generally contracted
pelvis with an oval shape, a high
sacrum, and inclination of the walls;
called also juvenile pelvis.

CharlieASjuntak, FKIK-Jam 9
Type of pelvis(8)
• Kyphotic pelvis a deformed pelvis
marked by increase of the conjugate
diameter at the brim with decrease of
the transverse diameter at the outlet.

CharlieASjuntak, FKIK-Jam 10
Type of pelvis(9)
• Otto pelvis one in which the
acetabulum is depressed, accompanied
by protrusion of the femoral head into
the pelvis.
• Platypellic pelvis (platypelloid pelvis)
one shortened in the anteroposterior
aspect, with a flattened transverse, oval
shape.

CharlieASjuntak, FKIK-Jam 11
Type of pelvis(9)
• Rachitic pelvis one distorted as a result
of rickets.
• Renal pelvis the funnel-shaped
expansion of the upper end of the ureter
into which the renal calices open
• Scoliotic pelvis one deformed as a
result of scoliosis.
• Split pelvis one with a congenital
separation at the symphysis pubis.
CharlieASjuntak, FKIK-Jam 12
Type of pelvis(10)
• Spondylolisthetic pelvis one in which
the last, or rarely the fourth or third,
lumbar vertebra is dislocated in front of
the sacrum, more or less occluding the
pelvic brim.

CharlieASjuntak, FKIK-Jam 13
Deformity of the pelvis
• Congenital
• Inflammation & Infection
• Degenerative
• Neoplasm
• Trauma

CharlieASjuntak, FKIK-Jam 14
Congenital of Pelvis
• CDH (Congenital Dislocation of the
Hip)

CharlieASjuntak, FKIK-Jam 15
Inflamation of Pelvic
• PID

CharlieASjuntak, FKIK-Jam 16
Degenerative of the pelvic
• Coxarthrosis

CharlieASjuntak, FKIK-Jam 17
Neoplasm of the Pelvic
• Primary neoplasm
• Secondary neoplasm
• Neoplasm of pelvic organ

CharlieASjuntak, FKIK-Jam 18
Trauma

CharlieASjuntak, FKIK-Jam 19
Trauma to pelvis

CharlieASjuntak, FKIK-Jam 20
Pelvic fracture classification:
Type A.

Stable.
Minimally displaced.
Posterior arch intact.
CharlieASjuntak, FKIK-Jam 21
Pelvic fracture classification:
Type B.

Can be unstable.
Incomplete disruption of posterior arch.
Actual or potential horizontal translation.
No vertical translation.
CharlieASjuntak, FKIK-Jam 22
Pelvic fracture classification:
Type C.

Unstable.
Complete disruption of posterior arch.
Actual or potential horizontal and vertical
displacement.

CharlieASjuntak, FKIK-Jam 23
Type I injuries:
• Mechanically stable (usually Type B
lateral compression).
• Haemodynamically stable.
• No emergency treatment for pelvic
lesion.
• Obtain CT scan.
• Liaise with pelvic fracture unit re
definitive management.
CharlieASjuntak, FKIK-Jam 24
Type II injuries:
• Mechanically unstable (open book
and Type C injuries).
• Haemodynamically stable.
• No emergency treatment for pelvic
lesion.
• Careful haemodynamic monitoring.
• Obtain CT scan.
• Liaise with pelvic fracture unit re
definitive management.
CharlieASjuntak, FKIK-Jam 25
Type III injuries(1)

• Mechanically stable (usually Type B

lateral compression).
• Haemodynamically unstable.
• Pelvis already closed/stable – no need
for emergency treatment for pelvic
lesion.

CharlieASjuntak, FKIK-Jam 26
Type III injuries(2)
• Look for bleeding elsewhere
(chest/abdomen).
• If none found, consider:
– Angiography/embolisation.
– Laparotomy/pack pelvis.

CharlieASjuntak, FKIK-Jam 27
Type IV injuries(1)
• Mechanically unstable (open book
and Type C injuries).
• Haemodynamically unstable.
• Look for bleeding elsewhere
(chest/abdomen).

CharlieASjuntak, FKIK-Jam 28
Type IV injuries(2)
• Reduce pelvic fracture and stabilise
with anterior external fixator or C-
clamp.
• If laparotomy indicated, you MUST
apply external fixator BEFORE
abdomen opened.

CharlieASjuntak, FKIK-Jam 29
Type IV injuries:(3)
• After external fixation, careful
haemodynamic monitoring.
• If continuing haemodynamic instability:
– Angiography/embolisation (if skills rapidly
available).
– Laparotomy/simple anterior plate
fixation/maintain external fixator/pack
pelvis.

CharlieASjuntak, FKIK-Jam 30
Type V injuries:(1)
• Mechanically unstable (open book
and Type C injuries).
• Haemodynamically unstable.
• Patient in extremis. Dying in front
of you despite aggressive fluid
resuscitation.
• Immediate operation required to
save life.

CharlieASjuntak, FKIK-Jam 31
Type V injuries:(2)
• Apply simple anterior external fixator
or C-clamp.
• Laparotomy and deal with any intra-
abdominal bleeding.
• If still haemodynamically unstable,
perform simple anterior plate
fixation/maintain external fixator/pack
pelvis.

CharlieASjuntak, FKIK-Jam 32
Percutaneous fixation
• Exposure not a problem • Detailed anatomical
• Low complication rate knowledge required
• Bio mechanically ideal • Technically demanding