Injuries of the pelvis

Prepared by ; Dr.Seerwan M J

Injuries of the pelvis

1. Introduction & Surgical Anatomy

2. Instability3. Clinical Assessment 4. Stable and unstable injuries5. Management

Introduction & Surgical Anatomy

• 5% of all skeletal injuries• Important !• 2/3 occur in RTA pedestrian• 10% associated visceral Inj.• 10 % Mortality

Introduction & Surgical Anatomy

• Stability depends on the Ligaments & bone

Introduction & Surgical Anatomy

• Common iliac artery, lumber & sacral plexusbladder , urethra.

Instability & trauma

Lateral focesV

ertical shear

Anterior force

Clinical Assessment

• Fracture pelvis Should be suspected in :– Abdominal or LL injuries– RTA, FFHPatient have severe pain, swelling, bruising of

lower abdomenInspection (lower abd., thigh, perineum,

scrotum , vulva)

Priority is to the patients’ general condition and blood loss , resuscitation before examination.

Clinical Assessment

• Abdomenal examination• Pelvic ring • Rectal examination• Urine color• (no catheter should be inserted)• Bladder injuries• Neurological

Clinical Assessment- radiology

Ap view with chest Xray can be obtained.

Exact imaging is

done when pt. tolerate

5 views necessary

CT is essential

Clinical AssessmentAp

Inlet view

Outlet view

Right obliqu

e

Left obliqu

e

Ap

Inlet view

best demonstrates ring configuration of pelvis, & narrowing or widening of diameter of ring is immediately apparent. - evaluates for posterior displacement of pelvic ring or opening of pubic symphysis

Outlet view

,shows the anterior ring superimposed on the posterior ring. - evaluates for vertical shift of pelvis (migration of hemipelvis); - proximal or distal displacements of anterior or posterior portion of ring are best appreciated on this view; - sacrum appears in its longest dimension, w/ neural foramina evident.

Right oblique

shows iliopectineal line anterior column of pelvis & posterior wall; -

Left oblique

shows ilioischial line (posterior) column & anterior wall;

Stable & unstable Injuries

Stable injuries1.ANTEROPOSTERIOR COMPRESSION (APC) INJURIES; APC I, APCII

2.LATERAL COMPRESSION (LC) INJURIE; LCI,LCII

Unstable injuries1.APCIII2.LCIII

3.VERTICAL SHEAR (VS) INJURIES

Full weight bearing without the risk of pelvic

deformity

Mx

1.Early managem

ent

2.Mx of sever

bleeding

3.Mx of the urethra and

bladder

4.Treatment of

fracture