PELVIC

FRACTURES
CC ISMAEL
EPIDEMIOLOGY
• Damage to the hip bones, sacrum, or coccyx
• Result of high energy trauma
• Low impact injuries
• Life threatening
• At risk of significant complications (e.g bleeding)
• Immediate vs Delayed treatment
• Only about 3% of all adult fractures
– Highest in those between the ages 15 and 28 years old.
ANATOMY
MECHANISM OF INJURY

• Low energy sec to muscle contractions in young adults

– Low impact injuries – seen more frequently in adolescents (athletic injuries –
avulsion fractures of superior or inferior iliac spines or apophyseal avulsion
fracture of the iliac wing or ischial tuberosity) and elderly (falls while
ambulating)
• High energy injuries result from MVA, falls from height, struck pedestrian
mechanism
– MVA (vehicle collision or pedestrian struck) or a fall from significant height
CLINICAL EVALUATION
• Assess patient
• Initiate resuscitation
– Blood loss of 8-10 units/1.5mL to 2L
– Femur: 1500mL
– Tibial/fibula fracture: 500 – 750 mL
• Evaluate other injuries
• Inspect for hematoma
• Palpate for instability
• DRE
• Urethral meatus
• Anus
• Vagina
RADIOGRAPHIC EVALUATION

• Standard trauma radiographs include AP view of chest, lateral cervical

spine, AP view of abdomen, AP view of pelvis
• Special views of pelvis – required in secondary survey
– Judet – used to evaluate acetabulum
– Inlet and outlet view of pelvis – evaluate pathology of pelvis ring
INLET VIEW

Patient is supine, and the beam is angled toward the pelvis

Shows narrowing or widening of diameter of ring
Shows posterior displacement of pelvic ring
Note opening of symphysis pubis
OUTLET VIEW

The beam is rotated distally and pointing towards pelvis about 45 degrees angle.
The anterior ring is superimposed on the posterior ring.
Evaluate for vertical shift of pelvis
The proximal or distal displacements of anterior or posterior portion of ring of sacrum
ROLE OF CT SCAN
• Detailed fracture anatomy
– Posterior elements
– Anterior elements
• Size and location of pelvic hematoma
• Hemorrhage
• Standard of care in pelvic fracture management
CLASSIFICATION
• In pelvic ring fractures, classification predicts resuscitative requirements as
well as outcome.
AP COMPRESSION– OPEN BOOK
LATERAL COMPRESSION
VERTICAL SHEAR
MANAGEMENT

• Recommended management varies and highlighting the fact that these are
difficult injuries to treat
• General treatment options
– External fixation – implants outside the skin
– Internal fixation – screws crosses the fracture line (eg. Screws, pins, nails)
COMPLICATIONS

• Hemorrhage, infections
• Thromboembolism: DVT
• Malunion
• Nonunion
• Infection
• Reproductive dysfunction