Pelvic Trauma Flashcards

Questions and Answers

Describe Tile's classification of pelvic fractures.

Describe the Young-Burgess classification of pelvic fractures.

Describe the fractures of individual pelvic bones.

List the five ligaments that maintain the integrity of the posterior arch.

Sacrospinous, Sacrotuberous, Iliolumbar, Anterior SI, Posterior SI. Signup and view all the answers

Describe the relationship between level and neurologic findings with transverse sacral fractures.

Rare at S4 and below, Common above S4. Signup and view all the answers

Describe a straddle fracture.

Four-pillar injury, Bilateral pubic rami 'butterfly segment', commonly associated with lateral compression or vertical shear forces, frequently associated injuries of GU tract. Signup and view all the answers

Describe an 'open book' pelvis.

Diastasis of pubic symphysis > 2.5 cm, disruption of the anterior (+/- posterior) ligaments, often associated with AP compression. Signup and view all the answers

List three bony injuries associated with vertical shear fractures.

Avulsion ischial spine, Avulsion lower lateral lip of the sacrum, Avulsion of the transverse process of L5. Signup and view all the answers

Describe the three types of vertical sacral fractures (Denis classification).

Fracture lateral to sacral foramina, Fracture through sacral foramina, Fracture medial to sacral foramina. Signup and view all the answers

List radiographic clues to posterior arch fractures.

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What physical exam maneuver do patients with pelvic fractures need?

DRE and vaginal exam to rule out open pelvic fracture. Signup and view all the answers

Describe the normal pubic symphysis and its relationship to pubic rami and SI joint distances.

Pubic symphysis < 5mm, Pregnancy pubic symphysis < 8mm, 1 - 2 mm vertical offset, NO overlapping of pubic symphysis, SI joint 2 - 4 mm wide. Signup and view all the answers

List the three mechanisms of pelvic fracture by their level of need for blood transfusions.

AP compression > vertical shear > lateral compression. Signup and view all the answers

List goals of management of pelvic fractures.

Resuscitation, Recognition, Evaluation, Stabilization, Control pelvic bleeding. Signup and view all the answers

What is a Malgaine fracture?

Fracture of the ilium near the SI joint with displacement of the symphysis OR a dislocation of the SI joint with fracture of both ipsilateral pelvic rami. Signup and view all the answers

Describe the typical 'dashboard' injury pattern to the lower limb.

Posterior hip dislocation, Posterior acetabular fracture, Sciatic nerve injury, Patella fracture +/- dislocation. Signup and view all the answers

Describe the avulsion fractures of the pelvis and their accompanying ligaments.

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List XR findings associated with bladder rupture.

Anterior arch fracture with, Diastasis of symphysis > 1 cm, Fracture around obturator ring > 1 cm displaced. Signup and view all the answers

List two pelvic fractures associated with urethral injury.

Malgagine, Straddle injury (butterfly). Signup and view all the answers

Study Notes

Tile's Classification of Pelvic Fractures

Categorizes pelvic fractures based on the involvement of the pelvic ring.

Young-Burgess Classification of Pelvic Fractures

Classifies fractures according to the mechanism of injury: lateral compression, anteroposterior (AP) compression, and vertical shear.

Individual Pelvic Bone Fractures

Includes distinct patterns and implications based on the specific bone involved.

Ligaments Maintaining Posterior Arch Integrity

Sacrospinous
Sacrotuberous
Iliolumbar
Anterior sacroiliac (SI)
Posterior sacroiliac (SI)

Neurologic Findings and Transverse Sacral Fractures

Rare neurological deficits at S4 and below.
More common deficits occur above the S4 level.

Straddle Fracture

Characterized as a four-pillar injury.
Involves bilateral pubic rami fractures resembling a butterfly segment.
Often linked to lateral compression or vertical shear forces resulting in posterior pelvic arch injury.
Frequently associated with genitourinary (GU) injuries.

"Open Book" Pelvis

Defined by diastasis of the pubic symphysis exceeding 2.5 cm.
Represents disruption of anterior (and potentially posterior) ligaments.
Typically results from anterior-posterior compression, often with vertical shear involvement.

Bony Injuries with Vertical Shear Fractures

Avulsion of ischial spine.
Avulsion of lower lateral lip of sacrum.
Avulsion of L5 transverse process.

Vertical Sacral Fractures (Denis Classification)

Lateral fractures to sacral foramina.
Fractures through sacral foramina.
Medial fractures affecting the central spinal canal (involving higher risk of neurologic compromise).

Radiographic Clues to Posterior Arch Fractures

Look for disruptions in the posterior arch on imaging.

Physical Exam Maneuvers for Pelvic Fracture

Digital rectal examination (DRE) and vaginal exams to rule out open pelvic fractures.

Normal Pubic Symphysis and SI Joint Distances

Normal pubic symphysis < 5 mm.
During pregnancy, pubic symphysis may reach < 8 mm.
Small vertical offsets (1-2 mm) possible between left and right pubic rami, with no overlapping of the symphysis.
Sacroiliac (SI) joint width ranges from 2-4 mm.

Mechanisms of Pelvic Fractures and Blood Transfusion Needs

Anteroposterior (AP) compression requires the most blood transfusions.
Followed by vertical shear fractures, with lateral compression needing the least.

Goals of Management for Pelvic Fractures

Resuscitation to address hemorrhagic shock.
Recognize posterior arch fractures due to higher hemorrhage risk.
Evaluate for serious accompanying injuries.
Stabilize the pelvis and proceed to definitive orthopedic fixation.
Control pelvic bleeding via angiography or pelvic packing.

Acetabular Fractures Classification

Classifies fractures specific to the acetabulum region.

Dashboard Injury Pattern to Lower Limb

Commonly results in:
- Posterior hip dislocation.
- Posterior acetabular fracture.
- Sciatic nerve injury.
- Patella fracture with or without dislocation.

Avulsion Fractures of the Pelvis and Ligaments

Avulsion fractures associated with specific ligaments at the pelvic region.

XR Findings Associated with Bladder Rupture

Anterior arch fracture accompanied by:
- Diastasis of the symphysis greater than 1 cm.
- Fracture around the obturator ring displaced over 1 cm.

Pelvic Fractures Associated with Urethral Injury

Malgaine fracture.
Straddle injury characterized as a butterfly effect.

Malgaine Fracture Definition

Fracture of the ilium near the sacroiliac joint with either displacement of the symphysis or dislocation of the SI joint, combined with fractures of both ipsilateral pelvic rami.
Commonly associated with urethral injuries.

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Description

Test your knowledge on pelvic trauma through these flashcards. This quiz covers Tile's classification, Young-Burgess classification, and individual pelvic bone fractures. Perfect for medical students and practitioners specializing in orthopedics and trauma care.