48. Pelvic trauma

Question 1

2 main classification schemes of pelvic fractures

Answer 1

1. Tiles

2. Young-Burgess

Question 2

3 types of # in Tile’s

Answer 2

A. Stable, posterior arch intact
b. Partially stable, incomplete disruption of posterior arch
C. Unstable, complete disruption of posterior arch

Question 3

4 main mechanisms in Young-Burgess classification

Answer 3

1. AP compression
2. Lateral compression
3. Vertical Shear
4. Combined

Question 4

4 types of stable pelvic ring fractures

Answer 4

1. Isolated pubic rami
   - stable
2. Inf and sup pubic rami
   - conservative treatment
3. Straddle
   - both rami on both sides
   - often GU injury
4. Isolated iliac ring
   - look for expansion into acetabulum

Question 5

4 main types of stable pelvic #s

Answer 5

1. Pelvic ring
2. Transverse sacrum
3. Avulsions
4. Stress #s

Question 6

MGMT of transverse sacral #

Answer 6

1. below S4 - conservative

2. Above s4 - ortho

Question 7

3 main sites of avulsion fractures and the muscles that pull them off

Answer 7

1. Iscial tuberosity
   - Hamstrings
2. Illiac crest
   - Abdo
3. ASIS
   - Sartorius

Question 8

What amount of pubic symphysis widening is considered stable?

Answer 8

<2.5cm

Question 9

Complications of AP compression

Answer 9

1. symphysis pubis widneing
2. SI joint separation
3. open book
4. neuro and vascular injuries

Question 10

Fractures involved in lateral compression injuries

Answer 10

1. bucket handle
2. Sacral and rami
3. separate symphysis
4. windswept pelvis

Question 11

4 major complications in vertical shear

Answer 11

1. Symphysis and rami disruption anteriorly
2. Posterior, gross displacement of rotational planes
3. Avulsion of ischial spine, lower lip of sacrum and L5 vertebra
   4 . Major hemorrhage

Question 12

3 grades (zones) of vertical sacral fracture

Answer 12

 lateral to sacral foramina
 through foramina
 medial to foramina involving central canal

Question 13

3 possible locations of open pelvic #s

Answer 13

1. Skin
2. Vagina
3. Rectum

Question 14

What fracture is most at risk of bladder injury

Answer 14

anterior arch

Question 15

4 tests of urinary tract injury

Answer 15

o retrograde urethrogram
o cystogram
o IV pyelography
o CT

Question 16

Deficits of L5 disruption

Answer 16

Weak - anterior tibial

Sense - dorsum of foot and calf

Question 17

Deficits of s1-2 disruption

Answer 17

Weak - hip ext, knee flex, plantar flex

Sense - posterior leg, sole of foot

Question 18

Deficits of s2-5 disruption

Answer 18

Weak - sex and bladder

Sense - perineum

Question 19

hallmark of acetabular #

Answer 19

pain and inability to weight bear

Question 20

3 Class of acetabular #s

Answer 20

A - # of one column
B - Transverse through both anterior and posterior column, but portion remains attached
C- Transverse through both anterior and posterior column, no portion remains attached

Question 21

MGMT of coccyx #

Answer 21

o	Limited activity
o	Stool softeners
o	Analgesia
o	Donut cushion
o	4-8 weeks pain

Question 22

What to assess on xray of pelvis (3)

Answer 22

1. symphysis
2. asymmetry in obturator foramina
3. avulsions

Question 23

4 findings that increase liklihood of transfusions needs

Answer 23

o Open book
o Displacement >0.5cm at any # in pelvic ring
o Displaced obturator #
o Vertical displacement

Question 24

5 goals of pelvic # related hemorrhage in ED

Answer 24

1. Resuscitate
2. Recognize - posterior arch
3. Evaluate - other injuries
4. Stabilize - bind pelvis
5. Control bleeding - angio