Podcast
Questions and Answers
Which anatomical structure is NOT part of the bony pelvis?
Which anatomical structure is NOT part of the bony pelvis?
- Femoral head (correct)
- Pubic bones
- Sacral bone
- Iliac bones
In an AP pelvis X-ray, what is the key first step in assessing the image for abnormalities?
In an AP pelvis X-ray, what is the key first step in assessing the image for abnormalities?
- Measuring the width of the symphysis pubis
- Evaluating the obturator foramina for symmetry
- Comparing one side of the pelvis to the other for symmetry (correct)
- Assessing the angle of the sacroiliac joints
What radiographic finding is most suggestive of a Malgaigne fracture?
What radiographic finding is most suggestive of a Malgaigne fracture?
- Isolated fracture of the pubic ramus
- Vertical shear injury with fractures of the pubic rami and disruption of the SI joint (correct)
- Fracture of the sacrum with associated rib fractures
- Bilateral pubic rami fractures without SI joint involvement
Which of the following mechanisms is most likely to cause an open book pelvic fracture?
Which of the following mechanisms is most likely to cause an open book pelvic fracture?
What is a common clinical finding associated with an open book fracture?
What is a common clinical finding associated with an open book fracture?
Which imaging modality is the most appropriate initial study for a suspected pelvic fracture in a trauma patient?
Which imaging modality is the most appropriate initial study for a suspected pelvic fracture in a trauma patient?
What is the distinguishing characteristic of a bucket-handle fracture of the pelvis?
What is the distinguishing characteristic of a bucket-handle fracture of the pelvis?
A patient presents after a straddle injury. What associated injury should the physician be most concerned about?
A patient presents after a straddle injury. What associated injury should the physician be most concerned about?
Typical radiographic signs of a straddle fracture include fractures involving which structures?
Typical radiographic signs of a straddle fracture include fractures involving which structures?
During initial trauma assessment, which imaging studies are typically included in the 'polytrauma x-rays protocol'?
During initial trauma assessment, which imaging studies are typically included in the 'polytrauma x-rays protocol'?
What is the primary role of the obturator canals in pelvic anatomy?
What is the primary role of the obturator canals in pelvic anatomy?
Which type of pelvic fracture is defined by a high-energy anteroposterior compression force, often resulting in significant blood loss?
Which type of pelvic fracture is defined by a high-energy anteroposterior compression force, often resulting in significant blood loss?
Which of the following is the least likely finding in a Malgaigne fracture?
Which of the following is the least likely finding in a Malgaigne fracture?
A patient presents with a suspected pelvic fracture after a motor vehicle accident. Besides an AP pelvis X-ray, what other imaging modality might be utilized to further evaluate the extent of the pelvic injury, especially in the presence of polytrauma?
A patient presents with a suspected pelvic fracture after a motor vehicle accident. Besides an AP pelvis X-ray, what other imaging modality might be utilized to further evaluate the extent of the pelvic injury, especially in the presence of polytrauma?
In a polytrauma patient, after the primary survey and initial resuscitation, which of the following is the most appropriate next step if a pelvic fracture is suspected based on clinical exam?
In a polytrauma patient, after the primary survey and initial resuscitation, which of the following is the most appropriate next step if a pelvic fracture is suspected based on clinical exam?
Which of the following is the MOST accurate description of a 'ring' within the context of pelvic anatomy and fracture patterns?
Which of the following is the MOST accurate description of a 'ring' within the context of pelvic anatomy and fracture patterns?
A 70-year-old female presents after a ground-level fall with hip pain. Radiographs reveal a fracture of the superior and inferior pubic rami on the right side. There is no evidence of sacral fracture or SI joint involvement. What is the most likely type of pelvic fracture?
A 70-year-old female presents after a ground-level fall with hip pain. Radiographs reveal a fracture of the superior and inferior pubic rami on the right side. There is no evidence of sacral fracture or SI joint involvement. What is the most likely type of pelvic fracture?
What is the significance of the 'pretzel analogy' when discussing pelvic anatomy?
What is the significance of the 'pretzel analogy' when discussing pelvic anatomy?
An elderly patient with osteoporosis sustains a ground-level fall. Radiographs reveal bilateral sacral ala fractures without disruption of the pelvic ring or pubic rami. What is the MOST appropriate next step in management?
An elderly patient with osteoporosis sustains a ground-level fall. Radiographs reveal bilateral sacral ala fractures without disruption of the pelvic ring or pubic rami. What is the MOST appropriate next step in management?
During a trauma evaluation, a patient is found to have an open pelvic fracture with gross contamination. Beyond standard ATLS protocols, what is the single MOST important intervention to improve patient outcomes?
During a trauma evaluation, a patient is found to have an open pelvic fracture with gross contamination. Beyond standard ATLS protocols, what is the single MOST important intervention to improve patient outcomes?
Flashcards
Open book fracture
Open book fracture
A fracture resulting from high-energy anteroposterior compression; pelvis is cracked open like a book.
Bucket handle fracture
Bucket handle fracture
Fracture through the ischiopubic rami on one side and the SI joint on the opposite side, commonly from a direct blow.
Malgaigne fracture
Malgaigne fracture
Unstable pelvic fracture with ipsilateral shortening of the lower extremity, fractures of the inferior and posterior pubic rami and ipsilateral SI joint widening.
Straddle fracture
Straddle fracture
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Polytrauma x-rays protocol
Polytrauma x-rays protocol
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Study Notes
- Objectives include identifying pelvic anatomical structures on imaging, ordering appropriate studies for pelvic fractures and polytrauma, and diagnosing specific pelvic fractures on imaging.
Anatomy of the Pelvis
- The pelvis consists of 3 connected rings.
- These rings make the pelvis like a pretzel.
- The sacral bone, iliac bones and pubic bones, and two obturator canals make up the pelvis.
- The 3 rings include the central pelvic inlet, right pelvis, and left pelvis.
Approach to Reading AP Pelvis X-Ray
- The approach to reading AP Pelvis X-rays include comparing one side of the "pretzel" to the other.
- Look for fracture lines in all 3 rings.
- Check for widening of SI joints and the pubic symphysis.
- Look for fracture lines within the iliac wings and sacrum.
Malgaigne Fracture
- Malgaigne fracture causes the shortening of the ipsilateral lower extremity.
- Diagnose with a Pelvis x-ray AP.
- It is an unstable pelvic fracture.
- Radiographs show a fracture of the ipsilateral inferior and superior pubic rami, along with widening of the ipsilateral SI joint.
Open Book Fracture
- Open book fracture results from a high-energy anteroposterior compression force applied to the pelvis.
- Common causes include motor vehicle accidents (MVA) and falls from significant heights.
- These fractures have a risk of significant blood loss and organ injury.
- Diagnose via X-ray pelvis AP.
- Radiographs often show fractures through the ischiopubic rami (or pubic symphysis) and SI joints on both sides, causing the pelvis to appear "open like a book."
- Radiographic findings include fracture of superior and inferior pubic rami, and the fracture of the bilateral SI joint.
Bucket Handle Fracture
- Bucket-handle fractures typically involve fractures through the ischiopubic rami on one side and the SI joint on the opposite side.
- Etiology is usually from a direct blow to pelvis.
Straddle Fracture
- Straddle fractures often occur in horseback riders, from a direct trauma mechanism.
- A known complication includes Urethral injury.
- Diagnose via AP pelvis x-ray.
- X-rays show fractures through both ischial rami and pubic rami; the small piece of bone containing the pubic symphysis is free to move.
- Radiographic findings include fractured superior and inferior pubic rami.
Polytrauma X-Rays Protocol
- Initial steps include lateral C-spine, AP Chest, AP Pelvis and E-Fast.
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