Pelvic fracture

Question 1

How is pelvic disruption classified?

Answer 1

Pelvis stability - Tile’s

Mechanism of injury - Young and Burgess

Question 2

Discuss Tile’s classification of pelvic disruption

Answer 2

Type A: Stable
A1 - fracture of the pelvis not involving the ring
A2 - iliac wing or anterior rami fractures
A3 - transverse sacral fracture
Type B: Rotationally unstable, vertically stable
B1 - unilateral anterior disruption of posterior structures
B2 - unilateral SIJ joint fracture
B3 - bilateral SIJ joint fracture
Type C: Rotationally and vertically unstable
C1 - complete unilateral posterior disruption
C2 - “ with contralateral partial disruption
C3 - complete bilateral posterior disruption

Question 3

Name conditions associated with pelvic disruption

Answer 3

OHANU

Open
Haematological
Associated
Neurological
Urological

Question 4

Name types of pelvic fractures

Answer 4

Isolated fractures
- avulsion
- stress
Pelvic ring fractures

Question 5

Where are the most common avulsion injuries of the pelvis seen?

Answer 5

Anterior inferior iliac spine

Ischial tuberosity

Question 6

Discuss Young and Burgess classification of pelvic disruption

Answer 6

1. Anteroposterior compression (APC)
   APC I - <2.5cm pubic diastasis
   APC II - >2.5cm pubic diastasis with anterior SIJ widening
   APC III - >2m5cm pubic diastasis with anterior and posterior SIJ dislocation
2. Lateral compression (LC)
   LC I - rami fracture and ipsilateral anterior sacral alar fracture
   LC II - rami fracture and ipsilateral posterior ilium fracture
   LC III - ipsilateral LC and contralateral APC
3. Vertical shear (VS)
4. Combined

Question 7

Which Young and Burgess fracture is called windswept pelvis?

Answer 7

LC III - ipsilateral LC and contralateral APC

Question 8

Which Young and Burgess classification is the most common type of pelvic ring fracture?

Answer 8

Lateral compression

Question 9

Which Young and Burgess fractures are associated with massive blood loss?

Answer 9

APC III
LC III
VS
Combined

Question 10

Discuss management of pelvic ring fractures

Answer 10

Stable = conservative management
- pelvic binder
- supportive
- early mobilization
Unstable = surgical management

Question 11

Discuss management of pelvic fractures if associated with urogenital injuries with urine leak from bladder or urethra

Answer 11

Treat fracture as open for 72h with antibiotics

Debridement and fixation once patient is stable

Question 12

Discuss management of pelvic fractures if associated with urogenital injuries with urine leak from bladder or urethra

Answer 12

Treat fracture as open for 72h with antibiotics

Debridement and fixation once patient is stable

Question 13

Discuss management of pelvic fractures if associated with urogenital injuries with intraperitoneal bladder rupture

Answer 13

Emergency laparotomy and direct repair

Question 14

Discuss management of pelvic fractures if associated with urogenital injuries with extraperitoneal bladder rupture

Answer 14

Conservatively unless pelvic fracture is unstable

Question 15

Name complications of pelvic ring fractures

Answer 15

Urethral stricture
Impotence
VTE
Nerve injury
Infection
Non-union

Question 16

Which nerve root is in danger during placement of the SI iliosacral screw?

Answer 16

L5

S1