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short presentation on the pelvis Injuries and Management in general , about bladder Injury, urethral injuries
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Injuries of the pelvis
Prepared by ; Dr.Seerwan M J
Injuries of the pelvis
1. Introduction & Surgical Anatomy
2. Instability3. Clinical Assessment 4. Stable and unstable injuries5. Management
Introduction & Surgical Anatomy
• 5% of all skeletal injuries• Important !• 2/3 occur in RTA pedestrian• 10% associated visceral Inj.• 10 % Mortality
Introduction & Surgical Anatomy
• Stability depends on the Ligaments & bone
Introduction & Surgical Anatomy
• Common iliac artery, lumber & sacral plexusbladder , urethra.
Instability & trauma
Lateral focesV
ertical shear
Anterior force
Clinical Assessment
• Fracture pelvis Should be suspected in :– Abdominal or LL injuries– RTA, FFHPatient have severe pain, swelling, bruising of
lower abdomenInspection (lower abd., thigh, perineum,
scrotum , vulva)
Priority is to the patients’ general condition and blood loss , resuscitation before examination.
Clinical Assessment
• Abdomenal examination• Pelvic ring • Rectal examination• Urine color• (no catheter should be inserted)• Bladder injuries• Neurological
Clinical Assessment- radiology
Ap view with chest Xray can be obtained.
Exact imaging is
done when pt. tolerate
5 views necessary
CT is essential
Clinical AssessmentAp
Inlet view
Outlet view
Right obliqu
e
Left obliqu
e
Ap
Inlet view
best demonstrates ring configuration of pelvis, & narrowing or widening of diameter of ring is immediately apparent. - evaluates for posterior displacement of pelvic ring or opening of pubic symphysis
Outlet view
,shows the anterior ring superimposed on the posterior ring. - evaluates for vertical shift of pelvis (migration of hemipelvis); - proximal or distal displacements of anterior or posterior portion of ring are best appreciated on this view; - sacrum appears in its longest dimension, w/ neural foramina evident.
Right oblique
shows iliopectineal line anterior column of pelvis & posterior wall; -
Left oblique
shows ilioischial line (posterior) column & anterior wall;
Stable & unstable Injuries
Stable injuries1.ANTEROPOSTERIOR COMPRESSION (APC) INJURIES; APC I, APCII
2.LATERAL COMPRESSION (LC) INJURIE; LCI,LCII
Unstable injuries1.APCIII2.LCIII
3.VERTICAL SHEAR (VS) INJURIES
Full weight bearing without the risk of pelvic
deformity
Mx
1.Early managem
ent
2.Mx of sever
bleeding
3.Mx of the urethra and
bladder
4.Treatment of
fracture