Pelvic fractures

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Normal anatomy: pelvis and proximal sacrum are angled posteriorly

pubic symphysis: up to 5mm in width, up to 2mm offset, no overlap

SI joints: 2-4 mm in width


checklist-

1)obturator foramina for symmetry-clue for rotation of film

2)diastasis of pubic symphysis and both SI joints

3)assymetry of illiac wings (rotation or deformity)

4)sacral foramina-especially the superior cortical margins

5)transverse processes of L5

6)integrity of all cortical lines, especially around acetabulum.


Outlet views-sacral fxs, SI joint abnormalities

Inlet view-displacement of ant. Fragments into pelvis..

(posterior abnormalities usually need CT )


Kane classification system:

type I-(stable) fracture of individual bones without a break in continuity of pelvic ring.


lower urinary tract injury;

pathway:

males-retrograde urethrogram, foley, retrograde cystogram, IVP

females-careful foley, retrograde cystogram, IVP.


Neurologic injuries

posterior ring or sacral fractures

1/3 of sacral fractures have neurologic involvement.

check bowel/bladder fxn , sensory levels...

sacral lesions can cause neurogenic bladder with overflow incontinence, sphincter dysfunction, or sexual dysfunction (eek)...

typeII-(stable) single breaks in the pelvic ring, non displaced, must look very hard for displacement.If anterior still a high rate of urinary tract infection.

type III- (unstable) double breaks or more in the ring:IIIA-Straddle fracture,IIIB Malgaigne fracture, IIIC severe multiple fractures

type IV- Acetabular fractures


Straddle Fracture:

Both rami fractured on both sides, or both rami on one side and diastasis of pubic symphysis.

caused by straddle injury or lateral compression., high rates of urinary tract injury and abdominal visceral injuries. Leg lengths are normal.


Malgaigne Fracture:

Anterior and posterior ring fractures on same side .

high rates of urinary and vascular injuries.

leg lngths areunequal, anterr illiac crest is displaced and or mobie


Bucket handle fracture

Anterr and poterior ring fractures on opposite sides. Anterior fracture is usually both pubic rami.

high rates ofurinary and vascular injuries


III-C Open book or sprung pelvis fracture

bilateral posterior ring fractures.