Pelvic Traumatology, Fractures

Dr Bakhtyar Baram

Epidemiology• Pelvis is normally very stabil but not in the osteoporotic pt.s.• Normally need ahigh force to make afracture like traffic accidents and fall from high.• Very close to other organs, lead to leasion of the other organs.• May be accompanied with other leasions –multitrauma pt. S-• Other fractures 85%• Lung 60%• CNS 40%• Abdomen 30%• UTS 12%• Cardiovascular 6%• Pelvic fractures is about 3% of all fractures.• In Europa about 30/100 000/year.

•

Isolated partial fractures• Partial small fractures in the pelvis occure most in the children and young

adults and mostly the tendon of one of the muscels will make asmall fracture in it s origion.like sartorius make spina iliaca ant. Sup., rectus femoris to spina iliaca ant. Inf., pubis ramis inf. With adduc. Longus ….etc

• Clinically the pt has pain and local tenderness,• Normally no need for any special treatment, bed rest and analgesic may

be enough.• When the callus start , the x-ray looklike metastase tumor.• Marginal fracture in Ilium bone occure most in osteoporotic pt.s or in the

ramus pubis inf or sup or both which no need for any special treatment, need early mobilization and analgesic with non wight-bearing for 2-3 weeks.

Pelvic ring fractures

• The pelvis is composed of 2 symettric parts , dislocation of that ring need a high energy power and normally will accompanied with other fractures in the pelvis, trauma mechanism is associated with the classification and the treatment.

• Classified to type A, B, C .

• Type A , Anteroposterior compression-APC-• A1: fracture without involving dobbelt ring.

• A2: stabil minimal dislocated.diastasis more marcked, may be slight separation of of SI joint but still satbil

• A3,APC 3, the ant and post. SI ligaments are torn,CT show separation of the joint,unstabil.

Type-Lateral compression-LC1 or B1 is normally stabile when the fracture occur in symphysis but there is not any dislocation posteriorly.But in type B2- can be stabile or unstable depending on the character, i.e. sacrum fracture or sacroiliac dislocation,B3 is unsabil or LC3

injuries, which cause an opposite force on the opposite illium .type C or vertical shear in which the hemi pelvis is totally disconnected , is unstable , involving ligament lesions,

Examination

• History is important.• Clinically , swelling, skin changes, hematomas, open

fractures, testing stability by palpation, find any tenderness, lower extremities, neurovascular changes, exam. Of testes,urethral meatus, abdomen and other regions.

• Normal x-ray of pelvis is indicated in all multitrauma pt. 30 degree x-ray from each side may be indicated.• CT or MRI is useful in these cases or indicated.

Evaluation and primary treatment. • Dislocated pelvic fractures has a high risk of mortality to over 50%.• Development in treating multitrauma pt.s decreaset that rate, like ATLS and etc.• The cause of that high mortality , most of them is multitrauma pt. s and have other organ

injuries and because of the bleeding which is uncontrolled.• It cause normally retroperitoneal bleeding from the vein plexuses or arteries,a. glutea sup. , a.

interna iliaca, or obturater a..,with open ring fractures the capacity of the pelvis for containing of the bleeding will increase.

• Fixing , or applying a pelvic binder, to achieve side to side compression is indicated to reduce the pelvic volume.

• Acute open operation to ligate the vessels may be indicated with internal fixation of the pelvis.• Primary resuscitation is necessary and may be indication for involving of other specialties ,

urogenital, abdominal, cardiovascular etc• Ultra sound exam. In the emergincy unit , CT or MRI will show the bleeding, rectum, úrethra

vagina and perinium leasions, • If there is sign of urethral tear , suprapubic cathetrization will be indicated .bladder wall

injuries, repair and all other urogenital operations will be done with the first operation

• In the stabil undislocated fractures without ligament tears can conservative treatment be used, , short bed rest with early mobilization will be effective with analgesics.

• In sever unstabil fractures will be depending on the other organ leasions but the reconstruction of the pelvis is best to be done with the other pelbic and abdominal operations.

• Types of fixation• External fixation which putts in ant. Cresta,it will give agood stability,

espicially with ant. Tears and can be used as permanent treatment.or can be used with other horizental fractures.it is easy and can be applied even in the small hospitals before transferring the pt to an other large hospital.2-3 pins in each side.

• Internal fixation may be, screw, fixation of symphesis .plate on illium or ant-post. Fixation of SI joint.

complications

• Thromoembolism• Sciatic or other nerve injury.• Urogenital problems, stricture, incontionence,

impotence.• Chronic sacroilliac pain.

thanks