Fracturte of the pelvis

Types of injury Injuries of the pelvis fall into four groups:

1- Isolated fractures with intact pelvic ring 2- Fracture with broken ring "Young and Burgess Classification" 4- combined
A- Avulsion fractures 1- Anteroposterior compression 2- Lateral compression A- Vertical shear
A piece if bone is pulled off by a violent muscle contraction. - Side on impact in a road accident
Frontal collision between a pedestrian and a car Fall from a height onto one leg
Sartorius pulls ASIS - Fall from a height on the side
Rectus femoris AIIS 1- Anteroposterior compression with lateral rotation may cause the ‘open 1- Lateral compression causing the ring to buckle and break; Vertical shear, with disruption of both :
Adductor longus piece of pubis book’ injury, the hallmark of which is diastasis of the pubic symphysis. 2- The pubic rami are fractured, sometimes on both sides. 1- the sacroiliac and
Hamstring part of ischium 2- Widening of the anterior portion of the sacroiliac joint is best seen on an 3- Posteriorly the iliac blade may break or the sacrum is crushed. 2- symphyseal regions on one side.
inlet view
B- Direct fracture
Direct blow to the pelvis fracture to ischium , iliac balde Provided Fractures of the iliac blade Reducation: of the vertical displacement by skeletal traction
1-the anterior gap is less than 2 cm A-Bed rest : Can often be treated with bed rest. Fixation :
C- Stress fracture 2-no displaced posterior disruptions, As these injuries represent loss of both anterior and posterior
B- Fixation :
Fractures of pubic rami in severly osteoporotic , osteomaclcic These injuries can usually be treated satisfactorily by bed rest; support, both areas will need to be stabilized.
pen reduction & internal fixation with plates and screws in :
1- Open
Reduction: Reduction posterior sling or a pelvic binder
bi helps to ‘close the book. Two techniques are used:
- If displacement is marked
no as there is no or minimal displacement (LL traction ) Fixation For 8-12 weeks 1- Anterior external fixation & posterior stabilization
bilization using screws
- If there is an associated anterior ring fracture
Immobilization : 1-External fixation: across the sacroiliac joint,
- symphysis separation,
These injuries need only bed rest, possibly combined with with pins in both iliac blades connected by an anterior bar. 2- Plating symphysis anteriorly & iliosacral screw fixation posteriorly.
lower limb traction 2-Internal fixation :
Duration : 2- External
xternal fixation.
by attaching a plate across the symphysis should be performed: Immobilization : remain in bed for at least 10 weeks.
Within 4–66 weeks the pa+ent is usually comfortable (1) during first few days a,er injury only if the pa+ent needs a laparotomy;
Rehabilitation: (2) and later on if the gap cannot be closed by less radical methods. - FIRST: Don’t forget to read the early emergency management of patient because most of them are multi-fracture
multi fracture trauma pa5ents. Apley P.357
A,er 4-66 weeks may then be allowed up using crutches. Rehabilitation: patient get up and walk around - Don't forget treatment of complications.
4- sacrococcygeal fractures 3- fractures of the acetabulum
acetabulu ""Judet-Letournel
Letournel Classification"

Acetabular wall fracture Anterior column fracture Posterior column fracture Transverse fracture complex fracture
Trauma :
Fractures runs upwards from the
A blow from behind, or a fall onto the'tail'may: Fractures of ant. Or post. Part of the Fracture runs through the anterior part of Fracture runs transversely throught the Damage various portions of the
obturator foramen into sciatic notch,
- fracture sacrum or coccyx acetabular rim affect Depth of the socket acetabulum , separating a segment acetabulum and separating : acetabulum including the roof & floor.
sepa
separating :
- Sprain the joint between them leading to hip instability , Unless: between: - Iliac portion above from
Post. Ischiopubic column of bone The articular surface is badly disrupted
- Ant. Inf. Iliac spine - Pubic ischial portions below
Leading to breaking weight-bearing
weight part
Treatment : Treated ( TTT) ORIF - Obturator foramen
of the acetabulum. If vertical split into obturator foramen TTT: ORIF
- The lower fragment maybe pushed backwards by a T –fracture
Doesn't involve the weight bearing area Associated with : Post. Hip dislocation
finger in the rectum
Good porgnosis TTT ORIF TTT: ORIF
- Use a rubber ring cushion when sitting.
- sacral fractures are associated with urinary Non
Non-Operative treatment Operative treament
problems, necessitating
cessitating sacral laminectomy. Indications :
Initial treatment ( emergency ttt ) cosists of :
- Persistent pain excision of the coccyx - The first priority is to counteract shock and reduce a dislocation. - all unstable hips and
- fractures resulting in significant distortion of the ball and socket congruence.
- Skeletal trac+on is then applied to the distal femur (10 kg will suffice)
- Associated fractures of femoral head
- Definitive treatment is delayed until the patient is fit and operation facilities are optimal.
- Retained bone fragments in the joint.
Definitive treatment :
- IF Undisplaced fractures or Fractures don't involve weight-bearing
weight bearing portion ( roof) of the acetabulum : Reduction: open reduction
maintaining trac+on for 6-8 weeks - Patients with isolated posterior wall fractures and dislocation may require immediate open ORIF.
- If the fracture is significantly displaced : - In other cases opera+on is usually deferred for 4 or 5 days.
1- closed reduction using using a cimpination of longitudinal & lateral skeletal traction Fixation :The
The fracture is fixed with lag screws or special buttressing plates which
wh can be shaped in the operating
o theatre.
2- If fails ORIF Immobilization: For 7days
Source: Apley's System of Orthopedics - Rehabilitation: Rehabilitation:
- The pa+ent is allowed up, par+al weightbearing with crutches, a,er 7 days. E
- During this period, hip movement and exercises are encouraged.
- Exercises are con+nued for 3–6 6 months; it may take a year or longer for full func+on to return.
- The patient is then allowed up, using crutches
crutches with minimal weightbearing for 6 weeks.