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Pelvic Fracture
Pelvis, Pelvic Fracture, Mechanism
- young: high energy trauma, either direct or by force transmitted longitudinally through the femur
- elderly: fall from standing height. low energy trauma
Clinical Features
- local swelling. tenderness
- deformity of lower extremity
- pelvic instability
Investigations
- x-ray: AP pelvis, inlet and outlet for pelvic fracture
o Judet films (obturator and iliac oblique) for acetabular fracture
o 6 cardinal radiographic Unes of the acetabulum: ilioischial line, iliopectlneal line, teardrop. roof, posterior rim. anterior rim
- CT scan useful for evaluating posterior pelvic injury and acetabular fracture
Table 4. Tile Classification of Pelvic Fractures (see Figure 11)
Type: Stability Description
A Rotationally stable Vertically stable
A1: fracture not involving pelvic ring
A2: minimally displaced fracture of pelvic ring {e.g. ramus fracture)
B Rotationally unstable Vertically stable
B1: open book
B2: lateral compression- ipsilateral
B3: lateral compression- contralateral
c Rotationally unstable
C1: unilateral Vertically unstable
C2: bilateral
C3: associated acetabular fracture
Treatment
- ABCs
- assess genitourinary injury (rectal exam, vaginal exam, hematuria, blood at urethral meatus)
o if involved, the fracture is considered an open fracture
- stable fractures - nonoperative treatment, protected weight-bearing
- indications for operative treatment
o unstable pelvic ring injury
o disruption of anterior and posterior SI ligament
o symphysis diastasis >2.5 cm
o vertical instability of the posterior pelvis
Specific Complications (see General Fracture Complications)
- hemorrhage (life-threatening) - 1500-3000 ml blood loss
- injury to rectum or urogenital structures
- obstetrical difficulties
- persistent sacroiliac (SI) joint pain
- post-traumatic arthritis of the hip with acetabular fractures
- high risk of DVT/PE