Pelvis Pathologies Flashcards
What are minimal displacement fractures associated with
major soft tissue damage - sharp edges of fractures can lacerate the soft tissue organs within
What do impact injuries do to the bone and what can the soft tissues around it do
impact injuries cause the bones to move out of position but the elastic recoil of the tissues can cause the bones to return to their original position
Why can diagnostic images be misleading and what is recommended
because they don’t reveal extent of injury and therefore CT is recommended to fully assess the damage
What does ABCs stand for
Alignment - of bones in relation to each other
Bones - is trabeculae pattern interrupted, definitive corticol outlines?
Cartilage - joint spaces widened
soft tissue - shadowing indicating swelling?/haemorrhage from internal bleeding? (causes the peri-vesical fat pad around bladder to become displaced) = both a result of pelvic trauma/# damage
Describe the Pelvis Ring
the pelvis has a main ring and 2 smaller obturator foramen
How is the stability of the pelvis maintained
by the strongest ligaments in the body
What are the name of the #s that are stable (don’t break the ring)
Avulsion #
Ischial/Pubic ramus #
Sacral #
Pubic Ramus # - most common in? result of?
most common in elderly as a result of a fall from a standing position or involvement in motor vehicle accident
Pubic Ramus # - symptoms? treatment? meds? recovery time?
experience groin & leg pain that may prevent them walking
typically heal without surgery and don’t usually cause permanent disabilities
Analgesics & non-steroidal anti-inflammatory meds used to treat symptoms
Pt encouraged to weightbear ASAP as pubic ramus has minor involvement in structural support
recovery = usually 2 months
What are 2 additional #s that are included as a stable #? result of?
Duverney # - vertically in periphery, often result from a direct blow
Avulsion # AIIS - often teens (14-17), most often in kicking sports
Sacral # - stable/unstable? most common in? result of?
can be stable and unstable depending on mechanism of injury
common in pelvic ring injuries (30-45%)
affects young adults = high energy trauma
affects elderly = low energy falls
What can happen if a sacral # goes undiagnosed? What is an important factor in predicting the outcome for a patient
may result in neurologic compromise (25% of these types of injuries are involved with this) - the presence of a neurological deficit is the most important factor in predicting outcome
Give 4 symptoms that are a result of a neurological deficit
lower extremity problems
urinary dysfunction
rectal dysfunction
sexual dysfunction
What is the difference between a stable sacral # and an unstable sacral # and how does the treatment differ?
Stable # - # with no neurological deficit = non-surgery / progressive WB activities
Unstable # - # with neurological deficit = surgical intervention needed with screw/plate/fixation
33% of pelvic #s are …
unstable and involve risk of haemorrhage
What is an indication of a break in the pelvic ring?
widening of the symphysis pubis or SI joints
How are #s classified?
by mechanism of injury as this results in different #s
Name 3 mechanisms of injury for a pelvic #
lateral compression
anterior compression
vertical shear
(complex - involve a combo of forces and results in a range of associated injuries)
What % of #s are lateral compression #s?
what could this be caused by?
results in?
around 60%
rollover motor vehicle accidents
causes superior and inferior ramus #s
vertical # of sacrum or sacral crush # and/or widening of SIJs
When does a lateral compression # occur?
when there is a internal rotation of 1 iliac wing causing a unilateral sacral compression # whilst the same forces cause external rotation of opposite hemi-pelvis resulting in diastasis of SIJ - WIND SWEPT PELVIS
What is the treatment for a lateral compression #?
simple incomplete # = non-operative and protective WB
more serious unstable # = surgical intervention, ORIF screws/plates
other surgery may be required if there is also injury to soft tissue organs of the pelvic cavity
What occurs as a result of an anterior compression # (OPEN BOOK)?
complex pelvic #
anterior compression force disrupts SIJs by more than 4mm causing diastasis of symph pubis of more than 5mm (pubic rami may be #’d in vertical orientation instead) and externally rotating each hemi-pelvis
What is the treatment for an anterior compression #?
If symph widening < 2.5cm = non-operable, protected WB
If symph widening > 2.5cm and SIJs affected = symphyseal plate/screws or external fixator used depending on severity of SIJ displacement
other surgery possibly required if there is injury to the soft tissue organs of the pelvic cavity
What is a vertical shear (vertical force) # a result of? what happens to the bones?
often suspected following a fall where force travels upwards through the body following impact / heavy weight falling onto shoulders
bones affected either crush/compress/fold inwards following vertical influence to the pelvis
Describe the Malgaigne # involved in a vertical shear # and how does it present
unstable and disrupts SIJ (considered a stabilising influence to the pelvis)
presents with shortening of the leg on the affected side
What is a common variant to a vertical shear # and what is the result of this variant
common variants involve the ileum/sacral wing rather than the SIJs
results in an unstable lateral fragment which contains the acetabulum
What is a further common association with a vertical shear #?
diastase of the symph pubis
What is a vertical shear #associated with? how is this rectified?
the highest risk of hypovolemic shock (decrease in volume of blood in body due to blood loss) - 63%
surgical intervention to rectify bony injury, involves stabilisation with plate/screws needed
What additional type of # is associated with anterior compression #s and vertical shear #s?
acetabular #s
