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AIP: Trauma > Pelvic fractures > Flashcards

Pelvic fractures Flashcards

1
Q

What is the benefit of classifying pelvis fractures?

A

helps to describe and direct treatment, as well as being able to predict the likelihood of other injuries

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2
Q

What are 3 aspects of the initial management of a pelvic fractures?

A
  1. Treat hypovolaemia
  2. Seek associated injuries
  3. Stabilise the pelvis with a commercial splint
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3
Q

What are the 4 key types of pelvic fractures according to the Young and Burgess pelvic fracture classification?

A
  1. Lateral compression (LC)
  2. Anterior posterior compression (APC)
  3. Vertical shear (VS)
  4. Combination
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4
Q

What is another name for anterior-posterior compression fracture of the pelvis?

A

open book fracture

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5
Q

What is the most common type of pelvic fracture?

A

lateral compression fractures

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6
Q

What do lateral compression fractures of the pelvis result in?

A

internal rotation of the affected hemi-pelvis

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7
Q

What type of mechanism of injury typically leads to lateral compression fractures?

A

side-on impacts in RTCs

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8
Q

What knock-on effect is there on the pelvic contents from lateral compression fractures?

A

pelvic volume is reduced, so bleeding is less of a problem than the associated head and intra-abdominal injuries

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9
Q

What types of lateral compression fractures are encompassed within this class of fractures?

A

range from simple to complex, multiple-traumatized (types I-III)

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10
Q

What is the common features of anterior-posterior compression fractures?

A

disruption to the pubic symphysis, caused by the ‘opening’ nature of the anterior-posterior comrpession forces (known as open book fractures)

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11
Q

What can be said about the stability of anterior-posterior compression fractures when involving the posterior sacro-iliac joints?

A

rotationally unstable and vertically stable

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12
Q

Under what circumstances may anterior-posterior compression fractures (open book fractures) be stable?

A

if no posterior component

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13
Q

What is the rate of pelvic bleeding like in anterior-posterior compression fractures and why?

A
  • rate of pelvic bleeding high (unlike lateral compression) due to increased pelvic volume
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14
Q

What may occur as a result of the high rate of pelvic bleeding in anterior-posterior compression fractures?

A

untamponaded haematomas expand rapidly into retroperitoneum

exsanguination may occur

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15
Q

What types of injury do anterior-posterior compression fractures have a strong association with?

A

brain and intra-abdominal injury

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16
Q

What is the initial life-saving therapy in anterior-posterior compression fractures?

A

application of a sheet or SAM splint (with sheet - tie it around pelvis in similar fashion as SAM in image)

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17
Q

What is typically the type of mechanism that causes vertical shear fractures of the pelvis?

A

typically result from a fall from height

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18
Q

What type of joints are typically affected in vertical shear fractures?

A

ipsilateral pubic rami and sacro-iliac joint disruption due to shearing forces

19
Q

What can be said about the stability of vertical shear fractures?

A

rotationally unstable and vertically unstable

20
Q

What are 4 types of pelvic fracture for which external fixation may be suitable?

A
  1. APC II/III
  2. LC II/III
  3. VS
  4. Combination
21
Q

What are the 2 key things to remember about pelvic fractures and the effect on pelvic volume?

A
  • lateral compression fractures: reduce pelvic volume
  • open book fractures (AP): increase pelvic volume
22
Q

What is the name of the classification system for the key types of pelvic fracture?

A

Young and Burgess pelvic fracture classification

23
Q

In addition to the types of fractures outlined by the Young and Burgess classification, what are 5 additional types of pelvic fractures to be aware of?

A
  1. Pubic rami fractures
  2. Avulsion fractures
  3. Minimally displaced ring fractures
  4. Coccyx fractures
  5. Sacral fractures
24
Q

What can typically be said about the stability of pelvic fractures outside of the Young and Burgess classification?

A

typically rotationally and vertically stable

either not involving pelvic ring or if they do are minimally displaced and hence stable

25
Q

What is generally the treatment of pelvic fractures outside the Young and Burgess classification system?

A

bed rest for analgesia and then mobilisation as pain allows

26
Q

In which patient group are pubic rami fractures common?

A

in elderly following falls

27
Q

What is the management of pubic rami fractures?

A
  • non-operative
  • analgesia and mobilisation as pain allows
  • may need referral to medical team/rehabilitation if unable to mobilise
28
Q

What determines whether follow up is neeed in fracture clinic for pubic rami fractures?

A
  • not required for simple fractures in elderly
  • can occur in younger patients due to trauma - follow up needed
29
Q

What is meant by pelvic avulsion fractures?

A
  • avulsion = injury to bone where tendon/ligament attaches, and it pulls off a piece of the bone
  • result of muscle contraction avulsing bony fragments
30
Q

Which age groups are affected by pelvic avulsion fractures?

A

all age groups e.g. young athletes and the elderly

31
Q

What is the management of pelvic avulsion fractures?

A
  • patients who can mobilise are sent home
  • management is conservative
  • open reduction + internal fixation can be considered later for painful non-unions
32
Q

What are 3 examples of typical muscles and associated fractures involved in avulsion fractures?

A
  1. Anterior superior iliac spine and sartorius
  2. Anterior inferior iliac spine and rectus femoris
  3. Iliac crest and abodminal muscles
33
Q

Which bones are typically affected by minimally displaced ring fractures of the pelvis?

A

superior pubic rami fractures and iliac wing injuries

34
Q

What is the management of minimally displaced ring fractures?

A
  • minimal displacement requires only symptomatic treatment
  • effective analgesia provided by sitting on rubber ring and avoiding constipation
35
Q

What typically causes coccyx fractures?

A

after falling in a seated position onto a hard surface

36
Q

Is routine x-ray indicated for coccyx fractures and what will it show?

A
  • no because doesn’t change management
  • if needed, lateral x-rays show variable fracture patterns
37
Q

What are 4 aspects of the management of coccyx fractures?

A

symptomatic treatment:

  1. effective analgesia provided by sitting on rubber ring and avoiding constipation
  2. all cases safely sent home with fracture clinic follow-up
  3. orthopaedic review/admission only needed if open fracture
  4. if painful non-union takes hold, excision can be performed
38
Q

What causes unstable sacral fractures?

A

associated with high energy transfer, are part of an unstable pelvic fracture pattern

39
Q

What is typically the cause of sacral fractures that are simple transverse fractures?

A

low energy falls typically in elderly -

40
Q

What can be said about the features of simple transverse fractures of the sacrum?

A

invariably non-displaced or minimally displaced

41
Q

What is the management of simple transverse sacral fractures?

A

symptomatic treatment

42
Q

What structures may be damaged in sacral fractures and what clinical effects can this result in?

A

sacral nerve roots may be involved, giving rise to lower limb neurological symptoms

43
Q

What investigation should be performed in patients with sacral fractures with suspected sacral nerve root involvement?

A

CT and MRI scans - to assess stability and nerve root involvement

44
Q

What is the management of sacral fractures with sacral nerve root involvement?

A

most should be admitted for investigation

short period of bed rest, followed by safe mobilisation

AIP: Trauma (20 decks)

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