Académique Documents
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Magnitude of Forces
Bone Anatomy
Ligamentous Anatomy
Ligaments - posterior
ligaments are stronger
than anterior ligaments:
Posterior SI
Anterior SI
Interosseous ligaments
Pubic symphysis
Sacrotuberous
Sacrospinous
ANATOMY
Ligamentous
ASI
ST
PSI
SS
ST
Posterior Ligaments
< 6 mm of translation
< 6 rotation
Intact cadaver resist 5,837 N (1,212 lbs)
ANATOMY
Relationships
Vascular Anatomy
Pelvic Stability
Physical Exam
Physical Exam-poor
sensitivity (8%) for
mechanically unstable
pelvis fractures in
blunt trauma patients
Radiographs
Anteroposterior (AP)
Inlet (40 caudad)
Outlet (40 cephalad)
CT scan
Judet (acetabular
fractures)
AP VIEW
INLET VIEW
Horizontal Plane
Rotation
Posterior
Displacement
Sacral ala
OUTLET VIEW
Sacrum
Cephalad
Displacement
Sacral Foramina
CT Scan
CT SCAN
3D CT
Translational Deformities
Rotational Deformities
Classification
Classification Systems
Anatomical (Letournel)
Stability & Deformity (Pennal, Bucholz,
Tile)
Vector force and associated injuries (Young
& Burgess)
OTA-research
Anatomical Classification
(Letournel)
Anterior
Rami fractures
Symphyseal disruption
Posterior
Pennal, 1961
Magnitude and
direction of forces
Lateral posterior
compression (LC)
Anterior posterior
compression (APC)
Vertical shear (VS)
Tile Classification
C-1 Unilateral,
complete disruption of
posterior arch
C-2 Bilateral,
ipsilateral complete,
contralateral
incomplete
C 3 Bilateral,
complete disruption
MECHANISM OF INJURY
Vertical shear
Combined injury
Young-Burgess Classification
LATERAL COMPRESSION
ring plus:
fracture of anterior
ANTERIOR-POSTERIOR COMPRESSION
APC
APC
APC
I Partial disruption
II Posterior sacroiliac ligaments intact
III Posterior sacroiliac ligaments
CLASSIFICATION
Mechanism and direction of injury
Posterior/SI injury is a
marker for associated
vascular injuries
Resuscitation
LC III
APC II
APC III
VS
CM
RESUSCITATION REQUIREMENTS
units blood
1st 24 hours
Mortality
Death
s:
J Ortho Trauma
Jul 2008
LATERAL COMPRESSION
LC I: Sacral compression
Lateral Compression
LC-I
LATERAL COMPRESSION
Common anterior pattern
LATERAL COMPRESSION
LC I: Sacral compression
Lefaivre KA, Padalecki JR, Starr AJ- J Ortho Trauma Jan 2009
LC I-Spectrum of injuries
LATERAL COMPRESSION
LC II: Iliac wing fracture
LC-II
LC-II
LC III
LC III
LC III
Anteroposterior Compression
ANTEROPOSTERIOR COMPRESSION
AP I: Hockey player
AP I
ANTEROPOSTERIOR COMPRESSION
APII: Open book pelvis
AP II
AP-II
AP II
Ligamentous pathology
AP II
These anterior SI ligaments are disrupted...
ANTEROPOSTERIOR COMPRESSION
APC III: Complete iliosacral dissociation
APC-3
AP III
APC-III
AP III
ASSOCIATED INJURIES
Lateral Compression:
AP Compression:
Urologic injury
Hemorrhage/pelvic vascular injury:
APCII-10%, APCIII-22%
Vertical Shear
Always unstable
Ant. symphsis or vertical rami fracturespost. Injury variable
Vertical displacement
VERTICAL SHEAR
Vertically unstable
often due to a unilateral injury.
Similar to APC3.
VERTICAL SHEAR
Combined vectors
occasionally 2 separate
injuries
(ejection/landing)
LC-I, AP-I
Conservative
Treatment
AP-II
AP-III, VS
Anterior
Stabilization
Anterior and
Posterior Stabilization
Furey AJ, OToole RV, Nascone JW, Sciadini MF- Ortho Oct 2010
ASSOCIATED INJURIES
Injuries
to the Rectum
Most commonly, injuries to the rectum occur with penetrating rather than blunt
pelvic trauma
Traditionally, rectal trauma had been managed with the principle of the four Ds:
divert, drain, direct repair, and distal washout
Challenging these current principles is difficult as extraperitoneal rectal injuries
are rare, limiting a large-scale study, and the clinical consequences of pelvic
sepsis without proximal diversion of the fecal stream can be a disastrous
scenario in an often already multiply injured patient
Although less common with blunt bony pelvic injury, 25 % of patients with an
open pelvic fracture have an associated rectal laceration (Jones-Powell class III)
In this study, the highest mortality and highest ISS scores were for patients with
a combination of open pelvic fracture and rectal laceration underscoring the
synergistic effect of combined pelvic injuries on mortality
Thank You