Chapter 97- Pelvic, Acetabular, and Sacral Fractures Flashcards

1
Q

corona mortis

A

anastamosis between the external iliac a(sometimes the deep inferior epigastic a) and the obturator artery

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2
Q

LC fracture patterns are associated with what other injury?

A

head injury (high rate of mortality)

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3
Q

LC1

A

pubic rami fx, plus sacral impaction

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4
Q

LCII

A

rami fractures plus crescent fracture of the sacrum
- or posterior sacral ligamentous injury

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5
Q

LCIII

A

windswept pelvis - rami plus crescent on one side, anterior sacral ligaments torn on contralateral side with external rotation deformity

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6
Q

APCI

A

pubic symphysis diastasis <2.5cm

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7
Q

APCII

A

anterior symphyseal widenind >2.5cm, anterior SI ligaments torn, poterior intact

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8
Q

APCIII

A

posterios SI ligaments torn - complete dissociation of the SI joint

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9
Q

APC injuries associated with what injuries?

A

visceral injuries

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10
Q

what does an inlet film demonstrate in SI fixation

A

anterior posterior extents of osseous safety

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11
Q

what does an outlet view demonstrate in SI fixation?

A

cranial-caudal extent of osseous safety

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12
Q

safe zone for SI screw insertion on a lateral of the sacrum?

A

postero superior or antero inferior
posteroinferior endangers s1 nerve root
anterosuperior endangers L5 nerve root

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13
Q

incidence of DVT in pelvic ring injuries

A

35-50%

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14
Q

elementary pattern acetabulum fractures

A

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)

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15
Q

elementary pattern acetabulum fractures

A

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)

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16
Q

what approach to use for posterior-ly based fractures?

A
  • posterior wall
  • posterior column
  • posterior wall posterior column
  • transverse
  • transverse-posterior wall
    +/- t-type

KOCHER LANGENBECK

17
Q

ilioinguinal approach

A
  • 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
18
Q

when to use an extended iliofemoral approach

A

chronic (>3weeks acetabulum)
complex abcs, sciatic buttress comminution

19
Q

Stoppa/AIP (anterior intrapelvic)

A

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

20
Q

maneuver for performing exam under fluoro of an acetabular fracture?

A

adduction, flexion, and internal rotation of the affected hip with gental axial force

21
Q

iliac oblique

A

anterior wall
posterior column
sciatic notch
iliac fossa

22
Q

obturator oblique

A

anterior column
posterior wall
obturator sulcus

23
Q

secondary congruence may be seen in what type of acetabular fractures

A

associated both column in the elderly

24
Q

HO prophylaxis options

A

indomethacin 25mg TID x 6-12 weeks
700cGy radiation within 72 hours of fracture fixation

25
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
26
Zone I sacral fracture
lateral to the foramen most common lowest incidence of neurologic injury
27
Zone II sacral fracture
thru the foramen 30% with unilateral nerve injury L5, S1, S2
28
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
29
APCIII fracture has highest risk of what of all the pelvic ring injuries
highest fluid requirements highest risk of hemorrhage highest risk of mortality