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PELVIC INJURIES High energy trauma. May be life threatening. Road traffic accidents. Fall from height. Crush injuries.

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SURGICAL ANATOMY

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CLASSIFICATION 1. ISOLATED FRACTURES Avulsion fractures. Direct fractures. Stress fractures.

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AVULSION FRACTURES

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2.FRACTURES OF PELVIC RING. 1. AP. COPRESSION (OPEN BOOK) APC-I APC-II APC-III 2. LATERAL COMPRESSION LC-I LC-II LC-III

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OPEN BOOK

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LATERAL COMPRESSION

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3. VERTICAL SHEAR

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CLINICAL FEATURES Stable injuries Pain and localized tenderness. Unstable injuries Shock, severe pain, diffused an severe tenderness, unable to stand. Pelvic and/or abdominal visceral injuries.

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FRACTURE OF PELVIS WITH VISCREL INJURIES.

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X-RAYS AP VIEW

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IN LET VIEW

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OUT LET VIEW

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MANAGEMENT According to ATLS protocol management is combination of assessment and treatment. 1-Air way 2-Breathing 3- Blood loss and shock 4- Visceral injuries 5- Fractures.

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FRACTURES MANAGEMENT Bed rest and analgesia For avulsion fractures, isolated and minimally displaced fractures. (4-6 weeks). SURGICAL INTERVENTION. (Indications) To control intra abdominal bleeding. Visceral injuries. Displaced fractures.

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SURGICAL PROCEDURES Pelvic bands. Skeletal traction. External fixation. Internal fixation with plate and screws.

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OPEN BOOK INJURY

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EXTERNAL FIXATOR

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PLATE AND SCREW

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VERTICAL SHEAR

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EXTERNAL FIXATOR

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PELVIC RING RESTORED

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COMPLICATION 1. Shock. 2. Visceral injury. 3. Thromboembolism. 4. Sciatic Nerve injury. 5. Urogenital problems. Persistent sacroiliac pain.

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ACETABULAR FRACTURES

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CLASSIFICATION A- Wall injuries. a- Anterior wall fractures. b- Posterior wall fractures. B- Column injuries. a- Anterior column fractures. b- Posterior column fractures. c- Both column transverse fractures. d- Both column T fractures.

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CLASSIFICATION

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CLINICAL FEATURES High energy trauma. Shock an associated injuries. Severe pain in hip joint. Unable to stand or walk.

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IMAGING X-RAY. 1. AP view. 2. Obturator oblique view. 3. Iliac oblique view. CT- Scan.

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X-RAY OUTLINE

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TREATMENT EMERGENCY TREATMENT. Follow the ATLS protocol. Apply skeletal traction 1. Longitudinal 2. May be needed additional lateral.

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NON OPERATIVE INDICATIONS 1. Minimally displaced (less than 3mm) intra articular fractures. 2. Fracture not involving the weight bearing (superomedial) area of acetabulum. 3. When traction is released and hip remains congruent.

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CONT. 4. Hip should not be dislocate able (posterior wall fracture). 5. Elderly and medically unfit patients. METHOD 1. Bed rest for un-displaced stable fracture. 2. Skeletal traction for 4-6 weeks, (displaced fractures) physiotherapy. Followed by gradual weight bearing.

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X-RAY (NON OPERATIVE)

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OPERATIVE TREATMENT INDICATION 1. Dislocate able and dislocated hip with acetabular fracture. 2. Articular incongruity more than 3 mm. 3. Involvement of superomedial, weight bearing area. METHODS Lag screws and/or special buttressing plates.

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INTERNAL FIXATION

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COMPLICATION Iliofemoral venous thrombosis. Sciatic Nerve injury. Myositis ossificans. A vascular necrosis. Osteoarthritis. Loss of joint movement.

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THANK YOU ALL HAVE A NICE DAY