Professional Documents
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Pembimbing :
Dr. Dicky Mulyadi, dr., Sp.OT(K)
Fractures of the pelvis : 5 per cent of all skeletal
injuries
high incidence of associated softtissueinjuries and
the risks of severe blood loss, shock, sepsis and adult
respiratory distress syndrome (ARDS)
two-thirds of all pelvic fractures occur in road
accidents involving pedestrians
ANATOMI PELVIS
Pelvis tdd:
1 sacrum
2 tulang innominata ilium, ischium dan pubis
Tulang-tulang innominata menyatu dengan sacrum di bagian posterior pada dua persendian sacroiliaca
di bagian anterior, tulang-tulang ini bersatu pada simfisis pubis
Simfisis bertindak sebagai penopang sepanjang memikul beban berat badan untuk mempertahankan
struktur cincin pelvis
The major branches of the common
iliac arteries arise within the pelvis
between the level of the sacroiliac joint
and the greater sciatic notch
With their accompanying veins they
are particularly vulnerable in fractures
through the posterior part of the pelvic
ring
The nerves of the lumbar and sacral
plexuses, likewise, are at risk with
posterior pelvic injuries
MEKANISME TRAUMA
Antero-Posterior Compression
Stress
fractures
sacrococcygeal
fractures
Clinical Feature
Open-book injuries
Provided the anterior gap is less than 2 cm and it is certain that there are
no displaced posterior disruptions,
these injuries can usually be treated satisfactorily by bed rest; a posterior
sling or a pelvic binder helps to ‘close the book’
The most efficient way of maintaining reduction is by external fixation
with pins in both iliac blades connected by an anterior bar; ‘closing the
book’ may also reduce the amount of bleeding
Internal fixation by attaching a plate across the symphysis should be performed:
(1) during the first few days after injury only if the patient needs a laparotomy;
(2) later on if the gap cannot be closed by less radical method
APC-III and VS injuries
These are the most dangerous injuries and the most difficult to treat
It may be possible to reduce some or all of the vertical displacement by skeletal traction
combined with an external fixator
the patient needs to remain in bed for at least 10 weeks, this prolonged recumbency is not
without risk
As these injuries represent loss of both anteriorand posterior support, both areas will need to be
stabilized
Acetabular fractures
(a) Fractures occur through the (b) Of particular importance is the roof (superior dome –
wall (rim) or supporting Columns which
Patterns of fracture
1. The anterior column fracture
from the pubic symphysis, along the superior pubic ramus, across
the acetabulum to the anterior part of the ilium
Operative treatment is indicated for all unstable hips and fractures resulting
in significant distortion of the ball and socket congruence
The hip may be dislocated centrally, anteriorly or posteriorly
Patients with isolated posterior wall fractures and dislocation may require
immediate open reduction and stabilization
In other cases operation is usually deferred for 4 or 5 days
Complications
A blow from behind, or a fall onto the ‘tail’ may fracture the sacrum or coccyx, or sprain
the joint between them
Women seem to be affected more commonly than men
Bruising is considerable and tenderness is elicited when the sacrum or coccyx is palpated
from behind or per rectum.
Sensation may be lost over the distribution of sacral nerves
Treatment
If the fracture is displaced, reduction is worth attempting
X-rays :
(1) a transverse fracture of the sacrum, in rare cases with the lower fragment pushed
forwards;
(2) a fractured coccyx, sometimes with the lower fragment angulated forwards; or
(3) a normal appearance if the injury was merely a sprained sacrococcygeal joint.