Chapter 97- Pelvic, Acetabular, and Sacral Fractures Flashcards
corona mortis
anastamosis between the external iliac a(sometimes the deep inferior epigastic a) and the obturator artery
LC fracture patterns are associated with what other injury?
head injury (high rate of mortality)
LC1
pubic rami fx, plus sacral impaction
LCII
rami fractures plus crescent fracture of the sacrum
- or posterior sacral ligamentous injury
LCIII
windswept pelvis - rami plus crescent on one side, anterior sacral ligaments torn on contralateral side with external rotation deformity
APCI
pubic symphysis diastasis <2.5cm
APCII
anterior symphyseal widenind >2.5cm, anterior SI ligaments torn, poterior intact
APCIII
posterios SI ligaments torn - complete dissociation of the SI joint
APC injuries associated with what injuries?
visceral injuries
what does an inlet film demonstrate in SI fixation
anterior posterior extents of osseous safety
what does an outlet view demonstrate in SI fixation?
cranial-caudal extent of osseous safety
safe zone for SI screw insertion on a lateral of the sacrum?
postero superior or antero inferior
posteroinferior endangers s1 nerve root
anterosuperior endangers L5 nerve root
incidence of DVT in pelvic ring injuries
35-50%
elementary pattern acetabulum fractures
anterior column
anterior wall
posterior column
posterior wall - gull sign on obturator oblique
transverse (looks like a line running anterior to posterior on an axial CT)
elementary pattern acetabulum fractures
posterior column-posterior all
transverse-posterior wall
t-type
anterior column - posterior hemitransverse
associated both column (spur sign - no articular piece connected to the ilium any longer)
what approach to use for posterior-ly based fractures?
- posterior wall
- posterior column
- posterior wall posterior column
- transverse
- transverse-posterior wall
+/- t-type
KOCHER LANGENBECK
ilioinguinal approach
- use for ABC, t-type, transverse, anterior column
- lateral window = subperiosteal dissection of the iliacus to the iliac fossa
- middle window = incise the external oblique and reflect it distal
– lateral portion of middle window contains iliopsoas tendon and femoral nerve
–medial portion of middle window contains inguinal a, veing, lymphatics
– iliopectineal fascia divides these two compartments - medial window = lateral mobilization of the spermatic cord or round ligament
- LFCN can be found just deep to the inguinal ligament at the AISI
when to use an extended iliofemoral approach
chronic (>3weeks acetabulum)
complex abcs, sciatic buttress comminution
Stoppa/AIP (anterior intrapelvic)
can be used as a substitute for the medial window (eg Stoppa/lateral window approach)
- retropubic dissection
- useful for intrapelvic work/reduction of the inner quadrilateral surface
- - associated both columns and anterior column fractures
maneuver for performing exam under fluoro of an acetabular fracture?
adduction, flexion, and internal rotation of the affected hip with gental axial force
iliac oblique
anterior wall
posterior column
sciatic notch
iliac fossa
obturator oblique
anterior column
posterior wall
obturator sulcus
secondary congruence may be seen in what type of acetabular fractures
associated both column in the elderly
HO prophylaxis options
indomethacin 25mg TID x 6-12 weeks
700cGy radiation within 72 hours of fracture fixation
to avoid avascular necrosis of the femoral head, care should be taken to protect what artery during ORIF of the acetabulum?
ascending branch of the medial femoral circumflex a
Zone I sacral fracture
lateral to the foramen
most common
lowest incidence of neurologic injury
Zone II sacral fracture
thru the foramen
30% with unilateral nerve injury L5, S1, S2
Zone III sacral fracture
medial to the foramen
highest rate of neurologic dysfunction
76% of patients with bowel, bladder, or sexual dysfunction
least common of the sacral fractures
APCIII fracture has highest risk of what of all the pelvic ring injuries
highest fluid requirements
highest risk of hemorrhage
highest risk of mortality
