Pelvic fractures
pelvis
Anatomy:
The pelvic ring is made of the two innominate
bones and the sacrum. Articulating in front at
the symphysis pubis , posteriorly articulating
with sacroiliac joints.
‫•مزيد من األحجام‬
‫•البحث بحسب الصور‬
‫•صور مشابهة‬
‫قد تكون الصور محمية بموجب حقوق النشر‪.‬‬
‫النوع‪:‬‬
‫‪JPG‬‬
Fractures of the pelvis
5% of all fractures
2/3 caused by road accident
-Carried high rate of mortality in
sever type, 10%.
(unstable type)
Types of fractures pelvis
1- Isolated fractures (with an intact ring).
2- Fracture with broken ring. (stable, unstable).
If the pelvis can withstand weight bearing
loads without displacement, it is stable
3- Fracture of acetabulum.
4- Sacrococcygeal fracture.
Isolated fractures with intact ring
• Avulsion fractures: e.g avulsion of anterior sup. iliac
spine by strong contraction of Sartorius muscle.
• Direct fractures: e.g. fall from height lead to fracture of
iliac blade, ischium.
• Stress fractures: e.g. fracture pubic rami in
osteoporotic patients .
Clinically in Isolated fractures with intact ring
The patient is not severely shocked but has
pain on attempting to walk. There is localized
tenderness but seldom any damage to pelvic
viscera. Treated by pain relieve, bed rest , for
1-3 weeks, physiotherapy of the lower limb
from the beginning.
Avulsion fracture of ant. Sup.
Iliac spine.
Avulsion fracture of ischial
tuberosity.
Fractures with a broken ring
• Stable ring fractures
• Undisplaced fractures of one or two ipsilateral
pubic rami.
• Fractures of the blade of ilium.
• Fractures of acetabulum.
Fracture pubic ramai
Fracture pelvic blade
Fracture acetabulum
Fracture pubic rami
Fracture acetabulum
Unstable ring fractures
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Caused by sever trauma.
Extremely serious.
Carries high risk of visceral injuries.
There are fractures around or separation of
symphysis pubis or sacroiliac joint.
Types of unstable fracture pelvic ring
• 1- antero-posterior compression (open
book).
• 2- lateral compression (closed book).
• 3- Vertical force cause vertical displacement of
the innominate bone on the same side.
• 4- combination injuries.
Clinically : These injuries caused by severe
trauma, extremely serious, carries high risk of
visceral injuries. There are fractures around or
separation of symphysis pubis or sacroiliac joint.
With unstable injuries, the patient is
a) severely shocked.
b) in great pain.
c) unable to stand.
d) Patient may be unable to pass urine(blood at
external meatus).
e) wide spread tenderness.
F) one leg may be partly anaesthetic due to sciatic
nerve injury.
Patient may be severely shocked due to blood
loss or visceral injury.
There may be swelling or bruising of the lower
abdomen, the thighs, the perineum, and the
scrotum or the vulva.
An inability to void and blood at the external
meatus, are the classic features of a ruptured
urethra (NO CATHETERIZATION).
A ruptured bladder should be suspected in
patients who do not void or in whom a
bladder is not palpable after adequate fluid
replacement.
Abdominal tenderness and guarding suggests
intraperitoneal bleeding (ruptured liver or
spleen) .
On examination :
Pain may be elicited by gentle but firm
pressure(from side to side on iliac crest), then
outwards, and then directly on symphysis
pubis.
Rectal examination is mandatory (High prostate
= urethral injury).
Neurological examination is essential to detect
lumbosacral plexus damage.
X- ray: Ideally five views should be obtained :
Standard anteroposterior view, inlet view,
outlet view, right oblique view, and left
oblique view, but x-ray shouldn't be done until
the patient become stable .
Treatment :
The first step make sure that airway is clear.
Active bleeding should be controlled.
shock treatment is the essential part of
management .
Severe bleeding is the main cause of death
following high-energy pelvic fractures. If
there is an unstable fracture of the pelvis,
hemorrhage will be reduced by rapidly
applying a pelvic binder or an external
fixator.
Treatment of the fracture
Open book injuries with a gap of less than 2cm
at the symphisis pubis can be treated with
bed rest for 6 weeks. If the gap is more than
2cm, external fixator with pins in the iliac
blades and anterior bar may be used for 8-12
weeks. The other option is anterior plating.
Severe vertical shear and compression injuries
are the most dangerous and most difficult to
treat. The fracture or dislocation must be
stabilized by external fixation or posterior
iliosacral screw or anterior plating with
posterior iliosacral screw . Vertical force
fractures may be treated by open reduction
and internal fixation or skeletal traction and
non weight bearing for 3 months