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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
References
. Classification of pelvic fractures: analysis of inter- and intraobserver variability using the Young-Burgess and
Tile classification systems.
Furey AJ, O'Toole RV, Nascone JW, Sciadini MF, Copeland CE, Turen C. Orthopedics. 2009 Jun;32(6):401
Interobserver reliability of the young-burgess and tile classification systems for fractures of the pelvic ring.
Koo H, Leveridge M, Thompson C, Zdero R, Bhandari M, Kreder HJ, Stephen D, McKee MD, Schemitsch EH.
Division of Orthopaedic Surgery; and daggerMartin Orthopaedic Biomechanics Lab, St. Michael's Hospital, Toronto,
Ontario, Canada. J Orthop Trauma. 2008 Jul;22(6):379-84
Fracture of the pelvis: current concepts of classification.Young JW, Resnik CS.Department of Radiology,
University of Maryland Medical System/Hospital, Baltimore 21201. AJR Am J Roentgenol. 1990 Dec;155(6):1169-75.
Do initial radiographs agree with crash site mechanism of injury in pelvic ring disruptions? A pilot study.
Linnau KF, Blackmore CC, Kaufman R, Nguyen TN, Routt ML Jr, Stambaugh LE 3rd, Jurkovich GJ,
Mock CN.Department of Radiology, Harborview Medical Center, Seattle, Washington 98104-2499, USA. J
Orthop Trauma. 2007 Jul;21(6):375-80.
References
How (un)useful is the pelvic ring stability examination in diagnosing mechanically unstable pelvic fractures in
blunt trauma patients? Shlamovitz GZ, Mower WR, Bergman J, Chuang KR, Crisp J, Hardy D, Sargent M,
Shroff SD, Snyder E, Morgan MT. Department of Emergency Medicine and Traumatology, Hartford Hospital, UCONN
School of Medicine, University of Connecticut, Hartford, Connecticut, USA. J Trauma. 2009 Mar;66(3):815-20
What constitutes a Young and Burgess lateral compression-I (OTA 61-B2) pelvic ring disruption? A description
of computed tomography-based fracture anatomy and associated injuries. Lefaivre KA, Padalecki JR, Starr AJ.
Department of Orthopaedics Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA. J Orthop
Trauma. 2009 Jan;23(1):16-21.
Predicting blood loss in isolated pelvic and acetabular high-energy trauma. Magnussen RA, Tressler MA,
Obremskey WT, Kregor PJ. Division of Orthopaedic Trauma, Vanderbilt Orthopaedic Institute, Nashville, Tennessee
37232-8774, USA. Orthop Trauma. 2007 Oct;21(9):603-7
Pelvic disruption: assessment and classification. Pennal GF, Tile M, Waddell JP, Garside H. Clin Orthop Relat Res.
1980 Sep;(151):12-21
Pelvic fractures: value of plain radiography in early assessment and management. Young JW, Burgess AR,
Brumback RJ, Poka A. Radiology. 1986 Aug;160(2):445-51
Acknowledgment
Andy Burgess and Kyle Dickson for
the use of their slides
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