Pelvis and Hip Trauma Flashcards
pelvic fractures can be classified as what
give explanation
stable or unstable
stable - single break - MC 2/3 of fractures
unstable - break in 2 or more places
xray trauma evaluation of pelvis requires which lines to be intact
iliopectineal (iliopubic) ilioischial teardrop symphysis pubis sacrum acetabulum shentons line arcuate lines of sacrum
anatomic pelvis is composed of 2 arches.. what are they
anterior and posterior
anterior - smaller arch, pubic and ischium along with pubic ligaments and pubic symphysis
posterior - larger arch, iliac wings and sarcum suspended by sacroiliac ligaments in the body
pelvic fracture evaluation requires to establish continuity using what 3 pelvic bony ring lines
pelvic inlet
pelvic outlet
obturator foramen
stability of pelvic fractures depends on where the fracture or dislocation disrupts what structures
pubic symphysis
sacroiliac joints
Most pelvic fractures result from what
MVA 50%
MV and person collision 30%
fall from height 10%
motorbike 4%
what types of pelvic fractures are common in elderly
insufficiency pelvic fractures
what is a stable pelvic fracture
what is a unstable pelvic fracture
stable - single break (MC)
unstable - break in 2 or more places
give an example of stable pelvic fractrue
avulsion fractures, iliac wing fracture, sacrum fracture, ischiopubic fracture
what hip fractures are most common among active adolescents and young adults
apophyseal fractures
pelvic and hip avulsion fractures usually occur in the age range of __ to __
what is mechanism of injury
14-25
kicking and gymnastics
sudden detachment of tendon
avulsion fracture of the hip may be mistaken for what
osteosarcoma
what is a stable* iliac wing* fracture resulting from direct blow that is usually treated conservatively unless it is comminuted
duverney fracture
what is an unstable* fracture of the hip that involves vertical shearing force* that causes an ipsilateral hemipelvic fracture* through ipsilateral rami and SI joint and ala
Malgaigne fracture
patient presents with short limb on one side of fracture, what is the fracture
malgaigne fracture
what unstable fracture results from lateral compression force such as car accidents
bucket handle fracture
what are vertically oriented fractures through the superior and inferior pubic rami on one side as well as contralateral SI joint disruption
bucket handle fracture
what unstable fractures the superior pubic ramus and ischiopubic junction bilaterally that causes bladder and urethral injury
straddle pelvic fracture
what pelvic fracture is often referred to as open book fracture
sprung pelvis fracture dislocation
what fracture is due to forced separation of the posterior ring through one or both SI joints with disruption of pubic symphysis and anterior ring diastasis
sprung pelvis fracture dislocation
what fracture causes the iliac wings to look asymmetrical
sprung pelvis fracture dislocation
proximal femur fractures tend to occur in what patients
elderly - especially with osteoporosis
proximal femur fractures is the result of high or low impact trauma in elderly
low
proximal femur fracture is the result of high or low impact in younger patients
high
why is femoral neck fractures dangerous
disrupts blood supply resulting in ischemic osteonecrosis/AVN of femoral head
intracapsular vs extracapsular prognosis
intracapsular worse cause affects blood supply
extracapsular does not affect blood supply
what are examples of intracapsular and extracapsular fractures of the femur head
intracapsular - supcapital, midcervical, basicervical
extracapsular - trochanteric and subtrochanteric
what classification method is used to determine and predict stability of injury
garden classification
many define basicervical fracture as what fracture
intertrochanteric
garden classication of femoral neck fractures
graden 1 - incomplete
garden 2 - complete but non displaced
garden 3 - complete and partially displaced
garden 4- complete and displaced entirely (fragments are not together)
what femoral neck fractures are diffucult to diagnose
undisplaced subcapital fracture - seen as line of sclerosis either complete or incomplete caused by impaction
patient presents with inability to walk or stand and their limb appears shortened and externally rotated
dispaced femoral neck fractures
intertrochanteric femoral fractures are result of what
violence, falls, car and pedestrian
what fractures of the femoral neck are more common in younger patients
interchocanteric and subtrochanteric fractures
extracapsular fractures such as intertrochanteric and subtrochanteric fractures often occur with significant force that results in what type of fracture
comminuted
what are complications of extracapsular fractures
fat pulmonary embolisms
subtrochanteric fractures occur 2 cm inferior to the ____
lesser trochanter
what population is more susceptible to hip dislocations
people with prosthesis his dislocated more readily and with less force
what is the most common hip dislocation
posterior
which hip dislocation is associated with acetabular fracture
central hip dislocation - protrusio
what is a complication of posterior hip location
damage sciatic nerve
posterior hip capsule damage
what is mechanism of posterior hip dislocation
MVA and dashborad injury
posterior dislocation causes damage to sciatic nerve which presents as what
unable to walk with general paresthesia in limb
in posterior hip location the femoral heads is displaced where? how is leg positioned
posterior, superior, and lateral
internally rotated - can barely seen less trochanter on xray
femoral head will also appear smaller on that side compared to other
what modality is needed for evaulation of posterior dislocation
CT
what sacral fractures are infrequet
isolated sacral fracture
isolated sacral fractures are often __ oriented and due to direct blow
transverse
when sacral fractures are part of complex injury they are usually ___ oriented and fracture through sacral foramen
vertical
sacral fractures that develop due to insufficiency and stress fractures that are ___ to SI joints
parallel
what do you look at on the sacrum to look for fractures
arcuate lines and sacral foramina
what classification is used to classify sacral fractures
Denis classification
zone 1
zone 2 - through sacral foramina
zone 3 - transverse down the middle
zone 4 - transverse - looks like a U - down sacral foramen then across then up sacral foramen
what other fractures in the vertebral column would indicate suspicion of sacral fracture
fracture of L4-L5 TP
what is another way besides CT and xray to view sacral fractures? what specific fracture
radionuclide bone scans - HONDA sign
insufficiency fracture
coccyx fractures result from what
falls on buttock and direct impact
