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 oflower extremity

· pelvic instability

· 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, tear drop. 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)

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

· 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

· 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