-
sacral fx MOI
- elderly fall
- young high energy (MVA)
-
sacral fx often associated w
- pelvis or spine fx
- nerve root injury
-
sacral fx: found on % of xrays?
50%
-
sacral fx: complications
- nerve root injury
- cauda equina syndrome (zone 3 fx)
- nonunion/malunion
- chronic pain
-
sacral fx: imaging
- AP pelvis
- lateral pelvis
- CT (if not seen on xray)
-
sacral fx: classification
- I. vertical denis
- II. transverse
- III. oblique
- complex
-
zone 1 sacral fx
vertical; lateral sacrum to foramina
-
zone 2 sacral fx
vertical; through the foramina
-
zone 3 sacral fx
vertical: medial to the foramina
-
complex sacral fx
"U" or "H" shape
-
tx for non or minimally displaced sacral fx
non op
-
tx for displaced or unstable sacral fx
- closed reduction and percutaneous fixation
- ORIF
-
tx for nerve injury in sacral fx
decompression
-
pelvic ring fx: avulsion of this structure suggests unstable fx
iliolumbar form L5 transverse process
-
most common pelvic ring fx
lateral compression
-
force causing LC1
posterior directed
-
force causing LC2
anterior directed
-
MOI of pelvic ring fx
high energy blunt trauma (MVA)
-
pelvic ring fx imaging
AP, inlet, outlet, CT loking for sacral, SIJ injuries
-
pelvic ring fx calssification system:
- Young and Burgess:
- AP compression
- Lateral compression
- Vertical Sheer
-
APC I
- <2.5cm pubic diastasis
- w 1 or 2 pubic rami fx
-
APCII
- >2.5 pubic diastasis
- w anterior SI injury
- vertically stable
-
APCII
- complete ant (pubic symphysis) and post (SIJ) disruption
- unstable
-
LCI
- sacral compression
- w ipsilatral rami fx
-
LCII
- LCI
- and
- iliac wing fx or post SIJ injury
- Vertically stable
-
LCIII
LCII with contralateral APCIII
-
-
vertical sheer pelvic ring fx
- SIJ and ST/SS ligaments disrupted
- w both rami fxs
- vertically unstable
-
WBAT
weight bearing as tolerated
-
which pelvic ring fx are non op?
-
complications of pelvic ring fx
- hemorrhage
- neurologic injuries
- malunion/nonunion
- chronic pain (SIJ)
- infection
- Thromboembolism
- fxnal disability
-
highest bleeding risk in pelvic ring fx
- venous> arterial
- internal pudendal artery!!> superior gluteal artery
-
pelvic fx MOI
low energy trauma (fall, sports)
-
imaging for pelvic fx
AP, inlet, and outlet
-
tx of pelvic avulsion
nonop unless widely displaced (then reattach)
-
acetabular fx MOI
- high energy blunt trauma (MVA)
- femoral head into the acetabulum
-
surgical approaches for acetabular fx
- kocher-langenbeck for posterior fx
- ilioinguinal for anterior fx
-
imaging for acetabular fx
AP, obturator oblique, iliac oblique, CT
-
roof arc angle
- on oblique (iliac and obturator) views:
- vertcal line to the center of acetabulum
- where fx line intersects acetabulum
- if <45 non op
-
acetabular fx classification system
- Letournel and Judet:
- elementary fx
- associated fx
-
acetabular fx: elementary fractures
- one of the following:
- - posterior wall
- - posterior column
- -anterior wall
- -anterior column
- -transverse
-
acetabular fx: associated fractures
- - post column and post wall
- - transverse and post wall
- - ant column and post hemi-transverse
- - both columns
-
acetabular fx non op if
- <2mm articular displacement
- roof arc angle >45
- posterior wall fx <20-30%
-
acetabular fx operative if
- 2mm articular displacement
- posterior wall >40%
- irreducible fx
- marginal impaction
- loose bodies in hip
-
non op tx acetabular fx is
NWB for 12wk
-
op tx acetabular fx is
ORIF and then 12wks NWB
-
complications of acetabular fx
post traumatic arthritis, sciatic nerve injury, post surgical heterotopic ossification, malunion/nonunion, infection, thromboembolism
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