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Ortho/fracture > Pelvis and Acetabulum > Flashcards

Pelvis and Acetabulum Flashcards

1
Q

Defined instability of the pelvis by Stress Views (two different numbers for the two authors provided)

A
  1. Tile - instability as greater than 0.5 cm of motion

2. Bucholz - greater than 1 cm of motion

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2
Q

Radiographic signs of pelvic instability (3)

A
  1. Sacroiliac displacement of 5 mm in any plane
  2. Posterior fracture gap (rather than impaction)
  3. Avulsion of the fifth lumbar transverse process, the lateral border of the sacrum (sacrotuberous lig), or the ischial spine (sacrospinous lig)
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3
Q

Classification system for pelvic fractures based on mechanism of injury

A

Young and Burgess

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4
Q

Young and burgess classification system (basic categories)

A

1: LC (lateral compression)
2: AP (anterior posterior compression)
3: VS (vertical)
4: Combined - combination of injuries usually from crush. most common is VS with LC

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5
Q

LC Young and Burgess Classification

A

Transverse (possibly oblique) fracture of pubic rami, ipsilateral or contralateral to posterior injury
Type I: SACRAL COMPRESSION ON SIDE OF IMPACT
Type II: CRESCENT (posterior iliac wing) FX ON SIDE OF IMPACT, variable disruption of post ligamentous structures resulting in variable mobility of anterior fragment to internal rotation stress.
Type III: LC I or LC II on side of injury, contralateral open - book (APC)/external rotation injury (WINDSWEPT PELVIS)

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6
Q

The usual cause of Retroperitoneal hemorrhage secondary to pelvic fractures is a disruption of what?

A

venous plexus in the posterior pelvis.

Other common causes: external or internal iliac disruption

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7
Q

AP Compression (APC) Young and Burgess Classification

A

External rotation injuries, Symphyseal diastasis or longitudinal rami fractures
Type I: Less than 2.5 cm of symphyseal diastasis; Vertical fxs of one or both pubic rami
Type II: More than 2.5 cm of symphyseal diastasis; widening of SI joints caused by anterior sacroiliac ligament disruption
Type III: Complete disruption of the symphysis, sacrotuberous, sacrospinous, and sacroiliac ligaments resulting in extreme rotational instability and lateral displacement; completely unstable.

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8
Q

Specific injury patterns seen in:

  1. AP force
  2. Lateral compression
A
  1. AP - results in external rotation of the hemipelvis; pelvis springs open, hinging on intact posterior ligaments
  2. Lateral compression - most common and results in impaction of cancellous bone through the SI joint and sacrum. Injury pattern depends on location of force - options include posterior half of ilium, anterior half of iliac wing, greater troch region, external rotation abduction force
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9
Q

Inlet view of the pelvis on radiograph (pt supine, tube directed 60 degrees caudally) is useful to depict:

A

Ant or Post displacement of the SI joint, sacrum, or iliac wing; may determine internal rotation deformities of the ilium and sacral impaction injuries.

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10
Q

Outlet view of the pelvis (pt supine, directed 45 degrees cephalad) is useful for:

A

Vertical displacement of hemipelvis

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11
Q

Young and Burgress VS class

A

Vertically or longitudinally applied forces; typically associated with complete disruption of the symphysis, sacrotuberous, sacrospinous, and SI ligaments resulting in extreme instability - symphyseal diastasis or vertical displacement ant or post, usually through the SI joint

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12
Q

Tile classification for pelvis

A

Type A: STABLE
A1: Fx of pelvis not involving the ring; AVULSION injuries
A2: Stable, MINIMAL displacement
A3: Transverse sacral fracture (Denis III)
Type B: ROTATIONALLY UNSTABLE, vertically stable
B1: EXTERNAL ROTATION injury, open book
B2: LC injury, INTERNAL ROTATION instability, ipsi only
B3: LC injury, BILATERAL rotational instability (BUCKET HANDLE)
Type C: ROTATIONALLY and VERTICALLY UNSTABLE
C1: UNILATERAL injury
C2: BILATERAL injury, one side ROTATIONALLY unstable and the other side VERTICALLY unstable
C3: BILATERAL injury, both sides ROTATIONALLY and VERTICALLY unstable with an associated acetabular fx

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13
Q

Eponym for skin degloving injury associated with pelvic fractures

A

Morel - Lavalle Lesion

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14
Q

Absolute Indications for Operative Tx of Pelvic Fxs

A
  1. Open pelvic fractures
  2. Associated visceral perforation requiring operative intervention
  3. Open - book fxs
  4. Vertically unstable fxs with associated patient hemodynamic instability
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15
Q

Relative Indications for Operative tx of pelvic fxs

A
  1. Symphyseal diastasis >2.5 cm
  2. Leg - length discrepancy >1.5 cm
  3. Rotational deformities
  4. Sacral displacement >1 cm
  5. Intractable pain
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16
Q

Operative Treatments for Pelvic fxs:

A
  1. External fixation - two to three 5 mm pins placed 1 cm apart along the Ant iliac crest, or with the use of a single pin placed in the supra-acetabular area in an AP direction (Hanover frame); only used for definitive treatment of anterior pelvis injuries
  2. Internal fixation
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17
Q

Internal fixation technique for:

  1. Iliac wing fractures
  2. Diastasis of pubes
  3. Sacral fxs
  4. Uni SI dislocation
  5. B/L Post Unstable
A
  1. Iliac wing - lag screws and neutralization plate
  2. Diastasis - plate fixation
  3. Sacral - transiliac bar fixation, or plate fixation or noncompressive iliosacral screw fixation
  4. Direct fixation with iliosacral screws or anterior SI plate
  5. Posterior screw fixation
18
Q

Denis Classification of Sacral Fractures and neurologic injury associated with each

A

Denis I: Lateral to foramen - 6% neuro injury
Denis II: Through foramen - 28% neuro injury
Denis III: Medial to foramen - 57% neuro injury

19
Q

Weight bearing status post op pelvic fractures:

A
  1. Full weight bearing on uninvolved LE within several days
  2. Partial WB on involved side for 6 weeks
  3. Full WB on affected side without crutches at 12 weeks
  4. Bilateral unstable - Partial WB on “less” injured side at 12 weeks
20
Q

A vascular communication between the external iliac or deep inferior epigastric and the obturator may be visualized withing the second window of the ilioinguinal approach, present in up to 10-15% of patients:

A

Corona Mortis

21
Q

Main blood supply to the femoral head:

A

Ascending branch of medial circumflex

22
Q

Direct impact to the greater troch with the hip in neutral position can cause what type of tab fx?

A

Transverse acetabular fx - abducted hip causes low transverse, adducted hip causes high transverse.

23
Q

Externally rotated vs internally rotated hip with direct impact of greater troch produces what fx?

A

ER and AB - anterior column injury

IR hip - posterior column injury

24
Q

Iliac oblique radiograph: what is it and what does it show?

A

45 degree external rotation view. Best demonstrates the posterior column (ilioischial line), the iliac wing, and the anterior wall of the acetabulum

25
Q

Obturator oblique view: what is it and what does it show?

A

45 degree internal rotation view. Best for evaluating the anterior column and posterior wall of the acetabulum

26
Q

Classification system for acetabulum fractures based on degree of columnar damage

A

Judet - Letournel

27
Q

The Judet - Letournel classification system is broken down into Elementary fractures and Associated fractures. What are the elementary fractures?

A 
Posterior wall
Posterior column
Anterior wall
Anterior column
Transverse
28
Q

The Judet - Letournel classification system is broken down into Elementary fractures and Associated fractures. What are the associated fractures?

A 
T - shaped
Posterior column and posterior wall
Transverse and posterior wall
Anterior column/posterior hemitransverse
Both - column
29
Q

Diagnostic sign above the acetabulum on an obturator oblique radiograph for a Both Column fx?

A

“Spur” sign

30
Q

Most common Elementary fracture pattern seen and “sign” associated with this on obturator oblique view?

A

Posterior wall; “Gull” sign on obturator oblique

31
Q

In posterior column acetabular injuries, where do you have to check for associated injuries?

A

Superior gluteal NV bundle

32
Q

6 radiographic landmarks of the pelvis:

A 
Iliopectineal line (anterior column)
Ilioischial line (posterior column)
Anterior rim
Posterior rim
Teardrop
Weight Bearing roof
33
Q

Indications for surgical fixation of acetabulum fractures - 7

A
  1. Displaced acetabular fractures >2 to 3 mm
  2. Inability to maintain a congruent joint out of traction
  3. Large posterior wall fragment > 40-50%
  4. Posterior instability under stress exam
  5. Intra-articular loose fragment
  6. Fracture - dislocation that is irreducible by closed methods
  7. Marginal impaction
34
Q

Surgical approaches to repair acetabular fractures - 4

A
  1. Anterior approach (ilioinguinal)
  2. Posterior approach (Kocher - Langenbach)
  3. Extensile approach (extended iliofemoral)
  4. Modified Stoppa approach
35
Q

Indications for anterior approach (ilioinguinal) - 4

A

Anterior wall
Anterior column
Both column
Posterior hemitransverse

36
Q

Major risks associated with anterior approach - 4

A

Femoral nerve injury
Lateral femoral cutaneous nerve injury
Thrombosis of femoral vessels
Laceration of corona mortis

37
Q

Indications for Posterior approach (Kocher - Langenbach) - 4

A

Posterior wall
Posterior column
Most transverse and T - shaped
Combination of above

38
Q

Major risks with posterior approach - 3

A

Increased HO risk
Sciatic nerve injury
Damage to medial femoral circumflex

39
Q

Extensile approach is the only approach that allows for DIRECT VISUALIZATION of both columns. What are the major risks with this approach? - 2

A

Massive HO

Posterior Gluteal muscle necrosis

40
Q

Indication for modified stoppa approach? Risk?

A

Access to quadrilateral plate to buttress medial wall comminuted fragment. Corona mortis must be ligated

Ortho/fracture (4 decks)

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