SAOP1- Pelvic Fractures

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  1. Pelvic fractures are usually __________ fractures.
    high-energy (therefore, the risk of concurrent injuries is very high)
  2. Displacement of any part of the pelvis implies that...
    • at least 2 (usually 3) fractures are present because the pubis, ischium, and ilium attach to the sacrum
    • Exceptions: young dogs in which SI and pubis are flexible or in racing greyhounds with stress fractures of the acetabulum
  3. If you have a patient with a pelvic fracture, ALWAYS...
    • evaluate for other traumatic injuries, especially thoracic trauma
    • ALWAYS take thoracic rads (hemo/ pneumothorax, pulmonary contusions, diaphragmatic hernia)
    • do a neurologic exam and monitor frequently
  4. What are important neurologic signs to test with pelvic fractures?
    • peripheral nerve damage is most likely and of imminent concern
    • examine reflexes- medial toe pinch only tests the femoral nerve, make sure you do lateral toe pinch to test sciatic nerve higher up
    • observe for voluntary movement
    • anal tone
    • urinary incontinence
  5. How do you position a patient for lateral radiographs?
    affected side down with hip flexes, upper hip extended (running man)
  6. Describe why there is usually favorable healing of pelvic fractures.
    • inherently stable structure that is surrounded by a large muscle mass with a good blood supply
    • ilium is mostly cancellous bone, which heals very quickly
  7. What are indications for surgical fixation of a pelvic fracture? (7)
    • fracture along a weight-bearing axis
    • articular fractures (acetabulum)
    • narrowing of the pelvic canal >50%
    • neurologic compromise (except if absent deep pain)
    • bilateral involvement
    • multiple limb fractures
    • intended use of the animal (working, breeding)
  8. Why is timing of pelvic fracture repair important?
    • repair within 5 days
    • it's difficult after 7-10 days because of initial fibrosis and muscle contracture
  9. What are 3 fracture types that are along the weight-bearing axis of the pelvis, and therefore indicate surgical repair?
    • ilial body fracture combined with pubic and ischial fractures (free-floating hip joint or free-floating acetabulum)
    • sacroiliac luxation
    • acetabular fracture
  10. Describe sacroiliac (SI) luxation.
    • traumatic separation of the wing of the ilium from the sacrum and craniodorsal displacement of the ilium relative to the sacrum
    • check for possible sacral nerve damage
  11. Describe the clinical aspects of sacroiliac luxation.
    • palpable laxity when you manipulate the wings of both iliums
    • usually associated with other pelvic fractures
    • on rad, you should be able to follow one contiguous line along the inside of the ilium into the sacrum; with SI luxation, you won't be able to do this
  12. When is conservative management of SI luxation indicated? (4)
    • little to no contralateral injury
    • minimal displacement
    • small dog or cat
    • minimal pain
  13. When is surgery to repair SI luxation indicated? (3)
    • moder to severe displacement (>50%)
    • palpable laxity
    • contralateral hindlimb fractures
  14. What are the goals of surgical repair of SI luxation? (3)
    decrease pain, improve recovery, earlier ambulation
  15. What are surgical methods for SI luxation repair?
    • dorsal or ventral approach (expose SI joint by brining ilium ventrocaudally)
    • lag screw across ilium into sacrum (largest cortical screw possible)- C-shaped cartilage is landmark for sacrum
    • trans-ilial bolt to the opposite ilial wing through dorsal spinous process of L7
    • trans-sacral bolt from one ilial wing to the other through the sacrum
  16. Describe an ilial body fracture. (4)
    • along the weight-bearing axis, so the majority of these fractures need surgery (except cats and small dogs)
    • commonly oblique
    • craniomedial displacement
    • usually associated with other fractures (ischium, pubis, +/- acetabulum)
  17. What are surgical approaches to ilial body fractures?
    • lateral approach- gluteal roll up- elevation of gluteal mm from ventral to dorsal from ilial wing--> reduction (challenging)--> bone plate
    • can place screw placed into sacral body for added purchased
  18. Describe ilial wing fractures. (4)
    • non-weight-bearing
    • non-articular
    • not associated with nerve entrapment or pelvic canal narrowing
    • NOT surgical cases
  19. Describe acetabular fractures.
    • crepitation on palpation of hip
    • DJD and lameness if untreated 
    • articular fractures always have guarded prognosis
    • good outcome dependent on meticulous reconstruction
    • always surgical cases
  20. What are the goals of fixation of acetabular fractures? (3)
    • perfect anatomic alignment
    • rigid fixation
    • promote primary bone healing (minimze callus formation within the joint)
  21. What are options for surgical treatment of acetabular fractures? (3)
    • primary repair- if reducible fracture, limited damage to cartilage
    • FHO-if highly comminuted or financial constraints
    • conservative treatment - if non-displaced or very caudal fractures (not recommended)
  22. When is FHO chosen as the surgical option for acetabular fracture?
    • Before sx- owner can't afford repair, highly comminuted fracture
    • In sx- repair cannot be accomplished
    • After sx- arthritis, consider THR
  23. When might sciatic nerve injury occur? What should be done about potential sciatic nerve damage?
    • injury from the initial trauma or surgical manipulation
    • if neuro signs are suggestive of sciatic damage, surgical exploration is recommended
    • if nerve is entrapped, free and stabilize the entrapping structure
    • if nerve is severed, amputation is indicated
  24. When do you repair ischial fractures?
    • repair if extremely painful or if fragment is severely displaced
    • [most will reduce when other pelvic fractures fractures are repaired]
  25. Describe pubic fractures.
    • very common with other pelvic fractures
    • generally left untreated, EXCEPT prepubic tendon avulsion, ventral abdominal wall hernia
  26. What are signs of separation of pelvic symphasis in young animals with SI luxation? (2)
    • dog unable to adduct hind limb
    • rotates when adduction muscle contracts
    • [treated by fixing SI luxation]
  27. Describe conservative therapy for pelvic fractures. (4)
    • analgesics
    • cage rest for 4-6 weeks
    • controlled exercise (using all 4 limbs)
    • recheck in 6-8 weeks with radiographs

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Author:
Mawad
ID:
325553
Filename:
SAOP1- Pelvic Fractures
Updated:
2016-11-10 14:53:30
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vetmed SAOP1
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vetmed SAOP1
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