(1,3) Pelvic Injuries Flashcards
What are the possible mechanisms of sacral fractures?
- fall on buttocks
- direct trauma
What is the most common type of sacral fracture?
horizontal sacral fracture
(3rd & 4th sacral level, below SI jt)
What is the best radiographic view for a horizontal sacral fracture?
lateral
What is the stability of an isolated horizontal sacral fracture?
stable
What is the mechanism of a vertical sacral fracture?
indirect trauma to pelvis (eg. land on 1 leg/buttock)
What is the clinical significance of a vertical sacral fracture?
50% pelvic organ damage
What radiographic view is best for a vertical sacral fracture?
AP only
What are the radiographic findings of a vertical sacral fracture?
disruption/offset/distortion of sacral foramina
What is the most common orientation of coccygeal fractures?
transverse (horizontal)
What other coccygeal injuries are associated with a fracture?
- anterior displacement
- subluxation or dislocation of sacrococcygeal jt
What radiographic view is best for coccygeal injuries?
lateral
What is the stability of an injury with 2 disruptions in the main pelvic ring?
unstable
What is the stability of an injury with 2 disruptions in an obturator?
stable
What are the 3 stable pelvic fractures?
- Duverney Fx
- Avulsion Fx
- Unilateral straddle Fx
What are the 6 unstable pelvic injuries?
- Malgaigne Fx
- Bucket-handle Fx
- Acetabular Fx
- Sprung pelvis
- Pubic diastasis
- Straddle Fx
What is the most common pelvic fracture?
malgaigne Fx
What is the mechanism of a Malgaigne fracture?
vertical shearing forces on pelvis (land on one side)
What is the stability of a Malgaigne fracture?
unstable
What are the 3 components of a Malgaigne fracture?
injury of:
- inf pubic ramus
- sup pubic ramus
- post arch
(all ipsilateral)
What posterior arch structures may be damaged in a Malgaigne fracture?
1 of the following:
- vertical sacral fx
- SI jt diastasis
- ilium fx
What is the mechanism of a bucket-handle fracture?
vertical shearing forces on pelvis
What is the stability of a bucket-handle fracture?
unstable
What are the 3 components of a bucket-handle fracture?
2 Ant. Ipsilateral fractures:
- inf pubic ramus
- sup pubic ramus
1 of Contralateral post arch inj:
- vertical sacral fx
- SI jt diastasis
- ilium fx
20% of all pelvic fractures involve what structure?
acetabulum
What are the 2 types of acetabular fractures?
- dashboard fx
- acetabular blowout fx
What part of the acetabulum is fractured in a dashboard fracture?
posterior acetabular rim
What is the mechanism of a dashboard fracture?
flexion + ABduction
(eg. knee hits dashboard, fem head hits acetabulum)
What is the stability of a dashboard fracture?
stable
(main pelvic ring intact)
What type of joint injury is associated with a dashboard fracture?
femoral dislocation
What part of the acetabulum is fractured in an acetabular blowout fracture?
central acetabulum
What is the mechanism of an acetabular blowout fracture?
side impact (eg. T-bone MVA = side impact on greater troch)
What is the stability of an acetabular blowout fracture?
unstable
What is the most common acetabular fracture?
acetabular blowout fx
What line is used to determine an acetabular blowout fracture?
Kohler’s/Ilioischial line
(should not intersect femoral head)
What is the most common form of unstable pelvic fracture?
straddle fx
What is a straddle fracture?
bilateral vertical fractures through both:
- sup pubic rami
- inf ischiopubic rami
What is the stability of a straddle fracture?
unstable
What is the stability of a unilateral straddle fracture?
stable
What is the clinical significance of a straddle fracture?
complications in 20% of pts:
- bladder rupture
- urethral tear
What is a sprung pelvis?
separation of:
- symphysis pubis AND
- 1 or both SI jts
What is the normal maximum measurement for pubic articulation in non-pregnant adults?
8mm
(may be wider in pregnancy)
What is the normal maximum measurement for pubic articulation in children?
10mm
A large traumatic separation of the anterior pelvis indicates what?
posterior injury
What is another name for a sprung pelvis?
open book pelvis
What is the mechanism of a sprung pelvis?
AP compression
What is the stability of a sprung pelvis?
unstable
What are 2 possible mechanisms of pelvic avulsion fractures?
- single episode trauma
- repetitive chronic trauma
What population most commonly experiences pelvic avulsion fractures?
adolescents & young adults
What muscle is associated with an ASIS avulsion fracture?
sartorius
What muscle is associated with an AIIS avulsion fracture?
rectus femoris
What muscle is associated with an ischial tuberosity avulsion fracture?
hamstring
What is Riders bone?
overgrowth of ischial tuberosity d/t unhealed avulsion & regrowth
(MC in equestrians)
What is the diagnosis?
sacral Fx
What is the diagnosis?
Ischial tuberosity adulation fx
What is the diagnosis?
Coccygeal fx
What soft tissue structure is associated with this diagnosis?
Hamstring
(Dx: ischial tuberosity avulsion Fx)
What is the diagnosis?
Sacral fx
What is the diagnosis?
AIIS avulsion fx
What is the diagnosis?
Duverneys fx
What soft tissue structure is associated with this diagnosis?
Rectus femoris
(Dx: AIIS avulsion Fx)
What is the diagnosis?
Malgaigne Fx
(Inf & sup pubic rami Fx + ipsilateral sacral ala Fx)
What is the diagnosis?
ASIS avulsion fx
What is the diagnosis?
Malgaigne Fx
What soft tissue structure is associated with this diagnosis?
Sartorious
(Dx: ASIS avulsion Fx)
What is the diagnosis?
Malgaigne Fx
What is the diagnosis?
ASIS avulsion Fx
What is the diagnosis?
Sprung pelvis / open book pelvis
What is the diagnosis?
Bucket handle fx
What is the diagnosis?
Sprung pelvis / open book pelvis
What is the diagnosis?
Dashboard fx
What is the diagnosis?
Pubic diastasis
What is the diagnosis?
Acetabular blowout fx
What is the diagnosis?
Saddle fx
What is the mechanism of injury?
Side impact
