Pelvis

Question 1

Pelvic fracture mechanism

Answer 1

• young: high energy trauma, either direct or by force transmitted longitudinally through the femur
• elderly: fall from standing height, low energy trauma
• lateral compression, vertical shear, or anteroposterior compression fractures

Question 2

Pelvic fracture clinical features

Answer 2

• pain, inability to bear weight • local swelling, tenderness • deformity of lower extremity • pelvic instability

Question 3

Pelvic fracture investigations

Answer 3

• X-ray: AP pelvis, inlet and outlet views, Judet views (obturator and iliac oblique for acetabular fracture)
■ 6 cardinal radiographic lines of the acetabulum: ilioischial line, iliopectineal line, teardrop, roof, posterior rim, anterior rim

• CT scan useful for evaluating posterior pelvic injury and acetabular fracture

• assess genitourinary injury (rectal exam, vaginal exam, hematuria, blood at urethral meatus)
■ if involved, the fracture is considered an open fracture

Question 4

Pelvic fracture classification

Answer 4

Tile Type A
Rotationally and vertically stable
A1: fracture not involving pelvic ring (i.e. avulsion or iliac wing fracture)
A2: minimally displaced fracture of pelvic ring (e.g. ramus fracture)
A3: transverse sacral fracture

Question 5

Pelvic fracture possible radiological findings

Answer 5

• Pubic rami fractures: superior/inferior
• Pubic symphysis diastasis: common in AP compression (N=5 mm)
• Sacral fractures: common in lateral compression
• SI joint diastasis: common in AP compression (N=1-4 mm)
• Disrupted anterior column (iliopectineal line) or posterior column (ilioischial line)
• “Teardrop” displacement: acetabular fracture
• Iliac, ischial avulsion fractures
• Displacement of he major fragment: superior (VS), open book (APC), bucket handle (LC)

Question 6

Pelvic fracture treatment

Answer 6

• ABCDEs

• non-operative treatment: protected weight bearing
■ indication: stable fracture

• emergency management 
■ IV fluids/blood 
■ pelvic binder/sheeting 
■ external fixation vs. emergent angiography/embolization 
■ ± laparotomy (if FAST/DPL positive) 

• operative treatment: ORIF
■ indications
◆ unstable pelvic ring injury
◆ disruption of anterior and posterior SI ligament
◆ symphysis diastasis >2.5 cm
◆ vertical instability of the posterior pelvis
◆ open fracture

Question 7

Pelvic fracture specific complications

Answer 7

• hemorrhage (life-threatening)
• injury to rectum or urogenital structures
• obstetrical difficulties, sexual and voiding dysfunction
• persistent SI joint pain
• post-traumatic arthritis of the hip with acetabular fractures
• high risk of DVT/PE

Question 8

Pelvic columns

Answer 8

posterior column

anterior column