Pelvic & Hip Trauma Flashcards
Pelvic injuries are among the most severe due to
bleeding and other internal
injury
Radiographic trauma evaluation of the pelvis requires that the following lines
should not be disrupted:
- Iliopectineal (iliopubic)
- Ilioischial
- teardrop
- symphysis pubis to the sacrum and the acetabulum
Anatomic Pelvic ring is composed of 2-arches:
Posterior (larger) and Anterior (smaller)
Most pelvic fractures result from:
- motor vehicle collision (50%)
- pedestrian vs. motor vehicle (30%)
Stable pelvic fractures
single break (about 2/3 of pelvic fractures)
relatively common
among physically active adolescents and young adults
Apophyseal avulsion fractures of the pelvis/hip (14-25 yrs)
stable iliac wing fracture resulting from a direct blow
Duverney fracture
involves vertical shear force and ipsilateral hemipelvic
fracture through ipsilateral pubic rami and sacroiliac joint or sacral ala
Malgaigne fracture
unstable and most common pelvic fracture?
Malgaigne fracture (short limb on fx side)
what view will show Malgaigne fracture?
AP pelvis
Vertically orientated fractures through the superior and inferior pubic rami on one side with contralateral sacro-iliac joint disruption
Bucket handle fractures of the pelvis (unstable)
Bucket handle fractures results from
lateral compression force (car accidents)
unstable fracture through superior pubic rami and ischiopubic junction bilaterally
Straddle pelvic fracture
Straddle pelvic fracture often have serious occurs.
bladder
and urethral injury
In males severe urethral injuries may result in
stricture
Due to
forced separation of the posterior ring through one or both sacroiliac joints with disruption of the pubis symphysis and anterior ring diastasis.
Sprung-pelvis fracture-dislocation
Sprung-pelvis fracture-dislocation is often referred to as
“open-book” pelvis.
iliac wings often
appears asymmetric in
Sprung-pelvis fracture-dislocation
Fracture of the femoral neck may lead to disruption of blood vessels,
resulting in
ischemic osteonecrosis or AVN of the Femoral head
: important because of their propensity to damage
the small intracapsular vessels that provide the majority of the blood supply
to the femoral head
Intra-capsular proximal femoral fracture
Extracapsular fractures do not usually cause
vascular damage
The trochanteric and subtrochanteric fractures are
extracapsular injuries
fractures is used to determine and
predict stability and associated complications with required treatment of subcapital neck fractures.
Garden classification
Radiographically detected only as a
line of sclerosis
undisplaced subcapital neck
fractures
responsible for undisplaced subcapital neck
fractures
Impaction fracture
Some complete displaced neck
fractures may mimic pathological
fractures and sometimes referred to
as
pseudopathological fracture
during complete displaced
neck fractures the patient will be
unable to walk or stand and their
limb may appear
shortened and
externally rotated
Intertrochanteric prox femoral fractures
are often the result of
violence
Intertrochanteric and subtrochanteric
fractures more readily develop in
younger patients
Extra-capsular proximal femoral fractures are often what type of fracture?
comminuted
Subtrochanteric fractures occur often
2-inches inferior to
lesser trochanter
most common hip dislocation
posterior (85%)
MVA = common mechanism
anterior hip dislocation occurs at around __ %
10
central hip dislocation (protursio) is always associated with
acetabular fracture
During posterior dislocations the _____ nerve can be potentially damaged
sciatic
In posterior dislocation femoral head is
displaced
posterior, superior, and slightly lateral to the acetabulum
In posterior dislocation femoral head is internally or externally rotated?
internally (lesser trochanter is obscured)
Isolated sacral fractures are often
transverse
When sacral fractures are part of complex pelvic injury they are usually _____
and fracture through the __________
vertical, sacral foramina
Sacral fractures associated with pelvic injuries often lead to serious damage to
pelvic/abdominal organs and vessels
When analysing radiographs for possible sacral fractures one needs to
specifically evaluate
arcuate lines and sacral foraminae
should alert for the possibility of sacral fracture
L4 and/or L5 TP fractures
