Pelvis Trauma

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Author:
medstudent2012
ID:
158669
Filename:
Pelvis Trauma
Updated:
2012-06-13 20:08:00
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Pelvis Trauma
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Description:
pelvis trauma
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  1. sacral fx MOI
    • elderly fall
    • young high energy (MVA)
  2. sacral fx often associated w
    • pelvis or spine fx
    • nerve root injury
  3. sacral fx: found on % of xrays?
    50%
  4. sacral fx: complications
    • nerve root injury
    • cauda equina syndrome (zone 3 fx)
    • nonunion/malunion
    • chronic pain
  5. sacral fx: imaging
    • AP pelvis
    • lateral pelvis
    • CT (if not seen on xray)
  6. sacral fx: classification
    • I. vertical denis
    • II. transverse
    • III. oblique
    • complex
  7. zone 1 sacral fx
    vertical; lateral sacrum to foramina
  8. zone 2 sacral fx
    vertical; through the foramina
  9. zone 3 sacral fx
    vertical: medial to the foramina
  10. complex sacral fx
    "U" or "H" shape
  11. tx for non or minimally displaced sacral fx
    non op
  12. tx for displaced or unstable sacral fx
    • closed reduction and percutaneous fixation
    • ORIF
  13. tx for nerve injury in sacral fx
    decompression
  14. pelvic ring fx: avulsion of this structure suggests unstable fx
    iliolumbar form L5 transverse process
  15. most common pelvic ring fx
    lateral compression
  16. force causing LC1
    posterior directed
  17. force causing LC2
    anterior directed
  18. MOI of pelvic ring fx
    high energy blunt trauma (MVA)
  19. pelvic ring fx imaging
    AP, inlet, outlet, CT loking for sacral, SIJ injuries
  20. pelvic ring fx calssification system:
    • Young and Burgess:
    • AP compression
    • Lateral compression
    • Vertical Sheer
  21. APC I
    • <2.5cm pubic diastasis
    • w 1 or 2 pubic rami fx
  22. APCII
    • >2.5 pubic diastasis
    • w anterior SI injury
    • vertically stable
  23. APCII
    • complete ant (pubic symphysis) and post (SIJ) disruption
    • unstable
  24. LCI
    • sacral compression
    • w ipsilatral rami fx
  25. LCII
    • LCI
    • and
    • iliac wing fx or post SIJ injury
    • Vertically stable
  26. LCIII
    LCII with contralateral APCIII
  27. windswept pelvis
    LCIII
  28. vertical sheer pelvic ring fx
    • SIJ and ST/SS ligaments disrupted
    • w both rami fxs
    • vertically unstable
  29. WBAT
    weight bearing as tolerated
  30. which pelvic ring fx are non op?
    • APCI
    • LCI
    • ramus fx
  31. complications of pelvic ring fx
    • hemorrhage
    • neurologic injuries
    • malunion/nonunion
    • chronic pain (SIJ)
    • infection
    • Thromboembolism
    • fxnal disability
  32. highest bleeding risk in pelvic ring fx
    • venous> arterial
    • internal pudendal artery!!> superior gluteal artery
  33. pelvic fx MOI
    low energy trauma (fall, sports)
  34. imaging for pelvic fx
    AP, inlet, and outlet
  35. tx of pelvic avulsion
    nonop unless widely displaced (then reattach)
  36. acetabular fx MOI
    • high energy blunt trauma (MVA)
    • femoral head into the acetabulum
  37. surgical approaches for acetabular fx
    • kocher-langenbeck for posterior fx
    • ilioinguinal for anterior fx
  38. imaging for acetabular fx
    AP, obturator oblique, iliac oblique, CT
  39. roof arc angle
    • on oblique (iliac and obturator) views:
    • vertcal line to the center of acetabulum
    • where fx line intersects acetabulum
    • if <45 non op
  40. acetabular fx classification system
    • Letournel and Judet:
    • elementary fx
    • associated fx
  41. acetabular fx: elementary fractures
    • one of the following:
    • - posterior wall
    • - posterior column
    • -anterior wall
    • -anterior column
    • -transverse
  42. acetabular fx: associated fractures
    • - post column and post wall
    • - transverse and post wall
    • - ant column and post hemi-transverse
    • - both columns
  43. acetabular fx non op if
    • <2mm articular displacement
    • roof arc angle >45
    • posterior wall fx <20-30%
  44. acetabular fx operative if
    • 2mm articular displacement
    • posterior wall >40%
    • irreducible fx
    • marginal impaction
    • loose bodies in hip
  45. non op tx acetabular fx is
    NWB for 12wk
  46. op tx acetabular fx is
    ORIF and then 12wks NWB
  47. complications of acetabular fx
    post traumatic arthritis, sciatic nerve injury, post surgical heterotopic ossification, malunion/nonunion, infection, thromboembolism

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