Common adult fractures Axial skeleton (Pelvis)

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Common adult fracturesAxial skeleton (Pelvis)

• Waleed M. Awwad, MD. FRCSC
• Assistant professor and Consultant
• Orthopedic Surgery department

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Pelvic fractures
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Epidemiology

• 37 cases per 100,000 / year at USA.
• Age
• Young high energy mechanisms.
• Elderly minimal trauma.
• Male are more commonly affected before the age of
  35.

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Anatomy
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Anatomy
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Anatomy
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Anatomy
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Pelvic stability

• Rotational or vertical.
• Sacroiliac displacement 5mm.
• Posterior fracture gap.
• Symphysis diastasis.
• Specific injury pattern (direction of force)
• AP ? external rotation of hemipelvis, spring
  open.
• LC (T-bone)
• Posterior half of ilium.
• Anterior half of iliac wing.
• Greater trochanteric region.
• External rotation and abduction, shear forces.

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Pelvic fracture patterns.
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Assessment

• ABCDEs must be assessed first and treated
  appropriately.
• Patients should be examined with spinal collar
  until spinal pathology is excluded.
• Careful log rolling keeping the head, neck and
  pelvis in line should be done to examine the
  spine properly.
• Pelvic stability test (AP-LC only once).
• Massive flank or buttock contusion.
• Palpation of posterior aspect, symphysis and
  perineum.
• Digital rectal and vaginal exam in any pelvic
  ring fractures.

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Assessment

• Hemodynamic status
• Usual cause of retroperitoneal hemorrhage is
  venous.
• Arterial bleeding
• Small vessels embolization
• Large vessels immediate surgical exploration.
• At emergency open book pelvic fracture.
• Pelvic wrapping at the level of GT.

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Assessment
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Assessment
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Associated injuries

• Neurological Lumbosacral plexus and nerve root.
• Genitourinary
• Bladder 20 incidence.
• Extraperitoneal foley if unable to pass.
• Intraperitoneal surgical repair.
• Urethral10 incidence. male gt females.
• Blood at meatus or catheterization, high ridding
  prostate.
• Any clinical suspicion ? retrograde urethrogram.
• Bowel perforation (open injury), rarely
  entrapment.
• Diverting colostomy.

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Radiographic evaluation

• AP pelvic view.
• Inlet and outlet views.
• Obturator and iliac oblique views if acetabular
  fracture.
• Computed tomography.
• MRI (limited clinical utility).

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Radiographic evaluation
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Management

• Depend on severity and stability.

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Management

• Depend on severity and stability.
• If stabile protected weight bearing and serial
  X-rays.
• If unstable
• External fixation.
• Internal fixation.
• Absolute surgical indication
• Open pelvic fractures.
• Open book pelvic fracture or vertical unstable.

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Acetabulum

• 3 per 100,000 population / year.
• Neurological injury up to 30 (peroneal division
  more than tibial).
• Components
• Anterior and posterior column.
• Acetabular dome (weight bearing area).

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Radiological

• Obturator and iliac oblique views
• Iliac oblique posterior column, iliac wing and
  anterior wall of the acetabulum.
• Obturator oblique anterior column and posterior
  wall of the acetabulum.

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Radiological
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Classification
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Management

• Goal of treatment is anatomic restoration of
  articular surface to prevent post traumatic
  arthritis.
• Non operative treatment
• Non displaced fracture or less than 2mm
  displacement.
• Less than 20 posterior wall fracture.
• Surgical treatment
• Displacement gt2mm.
• Large posterior wall fragment.
• Intra-articular fragment.
• Irreducible fracture dislocation.
• Posterior instability.

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Questions