Pelvic fractures are a disruption in the cortex of a pelvic bone Pelvic bone Bones that constitute each half of the pelvic girdle in vertebrates, formed by fusion of the ilium; ischium; and pubic bone. Pelvis: Anatomy involving iliac wing fractures, acetabular fractures, or those causing loss of integrity of the pelvic ring (the sacrum Sacrum Five fused vertebrae forming a triangle-shaped structure at the back of the pelvis. It articulates superiorly with the lumbar vertebrae, inferiorly with the coccyx, and anteriorly with the ilium of the pelvis. The sacrum strengthens and stabilizes the pelvis. Vertebral Column: Anatomy and the 2 innominate bones). Patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship often present with a history of trauma or a fall, limb length discrepancy Length Discrepancy Blount’s Disease, intense pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways on palpation Palpation Application of fingers with light pressure to the surface of the body to determine consistency of parts beneath in physical diagnosis; includes palpation for determining the outlines of organs. Dermatologic Examination, and mechanical instability. Elderly patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship with osteoporosis Osteoporosis Osteoporosis refers to a decrease in bone mass and density leading to an increased number of fractures. There are 2 forms of osteoporosis: primary, which is commonly postmenopausal or senile; and secondary, which is a manifestation of immobilization, underlying medical disorders, or long-term use of certain medications. Osteoporosis may have nontraumatic fragility fractures. Diagnosis is made clinically and confirmed with diagnostic imaging. Initial management includes control of bleeding, fluid resuscitation Resuscitation The restoration to life or consciousness of one apparently dead. . Neonatal Respiratory Distress Syndrome, and mechanical fixation. Surgery is often indicated in patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship with high-energy trauma. After recovery, decreased quality Quality Activities and programs intended to assure or improve the quality of care in either a defined medical setting or a program. The concept includes the assessment or evaluation of the quality of care; identification of problems or shortcomings in the delivery of care; designing activities to overcome these deficiencies; and follow-up monitoring to ensure effectiveness of corrective steps. Quality Measurement and Improvement of life may be reported.
Last updated: 3 May, 2022
A pelvic fracture Fracture A fracture is a disruption of the cortex of any bone and periosteum and is commonly due to mechanical stress after an injury or accident. Open fractures due to trauma can be a medical emergency. Fractures are frequently associated with automobile accidents, workplace injuries, and trauma. Overview of Bone Fractures is a disruption in the cortex of 1 of the pelvic bones. These fractures include iliac wing fractures, acetabular fractures, and the pelvic ring (the sacrum Sacrum Five fused vertebrae forming a triangle-shaped structure at the back of the pelvis. It articulates superiorly with the lumbar vertebrae, inferiorly with the coccyx, and anteriorly with the ilium of the pelvis. The sacrum strengthens and stabilizes the pelvis. Vertebral Column: Anatomy and the 2 innominate bones).
Several bones create a bony ring, meeting at the pubic symphysis Pubic Symphysis A slightly movable cartilaginous joint which occurs between the pubic bones. Vagina, Vulva, and Pelvic Floor: Anatomy in the front and the sacrum Sacrum Five fused vertebrae forming a triangle-shaped structure at the back of the pelvis. It articulates superiorly with the lumbar vertebrae, inferiorly with the coccyx, and anteriorly with the ilium of the pelvis. The sacrum strengthens and stabilizes the pelvis. Vertebral Column: Anatomy in the back.
Diagram of the pelvic bones
Image by Lecturio. License: CC BY-NC-SA 4.0Medial view of the hip bone Bone Bone is a compact type of hardened connective tissue composed of bone cells, membranes, an extracellular mineralized matrix, and central bone marrow. The 2 primary types of bone are compact and spongy. Bones: Structure and Types, featuring its components: the ilium (green), ischium (yellow), and pubis (blue)
Image by BioDigital, edited by Lecturio.Lateral view of the hip bone Bone Bone is a compact type of hardened connective tissue composed of bone cells, membranes, an extracellular mineralized matrix, and central bone marrow. The 2 primary types of bone are compact and spongy. Bones: Structure and Types, featuring its components: the ilium (green), ischium (yellow), and pubis (blue)
Image by BioDigital, edited by Lecturio.Anterior view of the pelvis Pelvis The pelvis consists of the bony pelvic girdle, the muscular and ligamentous pelvic floor, and the pelvic cavity, which contains viscera, vessels, and multiple nerves and muscles. The pelvic girdle, composed of 2 “hip” bones and the sacrum, is a ring-like bony structure of the axial skeleton that links the vertebral column with the lower extremities. Pelvis: Anatomy, featuring the supporting ligaments of the joints of the pelvic girdle
Image by BioDigital, edited by Lecturio.Lateral view of the hemipelvis, featuring the greater and lesser sciatic foramina
Image by BioDigital, edited by Lecturio.Acetabular columns
Image by Lecturio.The Young-Burgess classification has 3 categories of pelvic fractures designated by mechanism.
Acetabular fractures are classified in detail by several systems (Letournel, Brandser and March, and Judet). In general, they are categorized into simple (single) or complex (multiple) fractures, named for their location(s):
Young-Burgess classification of pelvic fractures
Image by Lecturio.Letournel classification of acetabular fractures:
Elementary acetabulum fractures
Letournel classification of acetabular fractures:
Associated acetabulum fractures
The examination of a pelvic fracture Fracture A fracture is a disruption of the cortex of any bone and periosteum and is commonly due to mechanical stress after an injury or accident. Open fractures due to trauma can be a medical emergency. Fractures are frequently associated with automobile accidents, workplace injuries, and trauma. Overview of Bone Fractures is done within the larger context of the trauma patient in the ED, following the advanced trauma life support (ATLS) method for assessment and simultaneous treatment of injuries. The pelvis Pelvis The pelvis consists of the bony pelvic girdle, the muscular and ligamentous pelvic floor, and the pelvic cavity, which contains viscera, vessels, and multiple nerves and muscles. The pelvic girdle, composed of 2 “hip” bones and the sacrum, is a ring-like bony structure of the axial skeleton that links the vertebral column with the lower extremities. Pelvis: Anatomy is a prominent source of bleeding and must be examined carefully, especially in hypotensive patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship.
It is essential to examine a patient with a suspected pelvic fracture Fracture A fracture is a disruption of the cortex of any bone and periosteum and is commonly due to mechanical stress after an injury or accident. Open fractures due to trauma can be a medical emergency. Fractures are frequently associated with automobile accidents, workplace injuries, and trauma. Overview of Bone Fractures for possible comorbidities Comorbidities The presence of co-existing or additional diseases with reference to an initial diagnosis or with reference to the index condition that is the subject of study. Comorbidity may affect the ability of affected individuals to function and also their survival; it may be used as a prognostic indicator for length of hospital stay, cost factors, and outcome or survival. St. Louis Encephalitis Virus.
Diagnosis of a pelvic fracture Fracture A fracture is a disruption of the cortex of any bone and periosteum and is commonly due to mechanical stress after an injury or accident. Open fractures due to trauma can be a medical emergency. Fractures are frequently associated with automobile accidents, workplace injuries, and trauma. Overview of Bone Fractures is initially made clinically and confirmed with visualization on diagnostic imaging. Patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship with a pelvic fracture Fracture A fracture is a disruption of the cortex of any bone and periosteum and is commonly due to mechanical stress after an injury or accident. Open fractures due to trauma can be a medical emergency. Fractures are frequently associated with automobile accidents, workplace injuries, and trauma. Overview of Bone Fractures involving the pelvic ring may also have urethral or bladder injuries Bladder Injuries Genitourinary Trauma; urgent urologic consultation is necessary.
X-ray
X-ray
Penetrating electromagnetic radiation emitted when the inner orbital electrons of an atom are excited and release radiant energy. X-ray wavelengths range from 1 pm to 10 nm. Hard x-rays are the higher energy, shorter wavelength x-rays. Soft x-rays or grenz rays are less energetic and longer in wavelength. The short wavelength end of the x-ray spectrum overlaps the gamma rays wavelength range. The distinction between gamma rays and x-rays is based on their radiation source.
Pulmonary Function Tests (AP
projection
Projection
A defense mechanism, operating unconsciously, whereby that which is emotionally unacceptable in the self is rejected and attributed (projected) to others.
Defense Mechanisms of the
pelvis
Pelvis
The pelvis consists of the bony pelvic girdle, the muscular and ligamentous pelvic floor, and the pelvic cavity, which contains viscera, vessels, and multiple nerves and muscles. The pelvic girdle, composed of 2 “hip” bones and the sacrum, is a ring-like bony structure of the axial skeleton that links the vertebral column with the lower extremities.
Pelvis: Anatomy) showing a pelvic
fracture
Fracture
A fracture is a disruption of the cortex of any bone and periosteum and is commonly due to mechanical stress after an injury or accident. Open fractures due to trauma can be a medical emergency. Fractures are frequently associated with automobile accidents, workplace injuries, and trauma.
Overview of Bone Fractures:
Note the widening of the
pubic symphysis
Pubic Symphysis
A slightly movable cartilaginous joint which occurs between the pubic bones.
Vagina, Vulva, and Pelvic Floor: Anatomy.
CT scan showing a fracture Fracture A fracture is a disruption of the cortex of any bone and periosteum and is commonly due to mechanical stress after an injury or accident. Open fractures due to trauma can be a medical emergency. Fractures are frequently associated with automobile accidents, workplace injuries, and trauma. Overview of Bone Fractures of the ilium
Image: “Trans-arterial and trans-venous interventional radiology Interventional radiology Subspecialty of radiology that combines organ system radiography, catheter techniques and sectional imaging. Penetrating Abdominal Injury for an elderly patient with life-threatening pelvic injury after accidental falling due to life-threatening cardiac Cardiac Total Anomalous Pulmonary Venous Return (TAPVR) arrhythmia: a case report” by Morozumi J, Arai T, Ohta S. License: CC BY 3.0Antero-posterior radiograph on the day of admission showing an anterior column Anterior column Spinal Cord: Anatomy fracture Fracture A fracture is a disruption of the cortex of any bone and periosteum and is commonly due to mechanical stress after an injury or accident. Open fractures due to trauma can be a medical emergency. Fractures are frequently associated with automobile accidents, workplace injuries, and trauma. Overview of Bone Fractures of the right acetabulum
Image: “F7: Case 4” by Fornaro J. et al AL Amyloidosis. License: CC BY 2.0An AP view of the right hip after injury shows a posterior wall and column fracture Fracture A fracture is a disruption of the cortex of any bone and periosteum and is commonly due to mechanical stress after an injury or accident. Open fractures due to trauma can be a medical emergency. Fractures are frequently associated with automobile accidents, workplace injuries, and trauma. Overview of Bone Fractures of the right acetabulum and a fracture Fracture A fracture is a disruption of the cortex of any bone and periosteum and is commonly due to mechanical stress after an injury or accident. Open fractures due to trauma can be a medical emergency. Fractures are frequently associated with automobile accidents, workplace injuries, and trauma. Overview of Bone Fractures of the ipsilateral inferior ramus of pubis.
Image: “F1: An AP view of the right hip after injury” by Zhang Y. et al AL Amyloidosis. License: CC BY 2.0For pelvic fractures that involve loss of integrity of the pelvic ring (the sacrum Sacrum Five fused vertebrae forming a triangle-shaped structure at the back of the pelvis. It articulates superiorly with the lumbar vertebrae, inferiorly with the coccyx, and anteriorly with the ilium of the pelvis. The sacrum strengthens and stabilizes the pelvis. Vertebral Column: Anatomy and the 2 innominate bones), definitive fracture Fracture A fracture is a disruption of the cortex of any bone and periosteum and is commonly due to mechanical stress after an injury or accident. Open fractures due to trauma can be a medical emergency. Fractures are frequently associated with automobile accidents, workplace injuries, and trauma. Overview of Bone Fractures management and bleeding control are carried out by the trauma and/or orthopedic surgeon. For pelvic fragility fractures in the elderly that do not require surgery, pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways control and early mobilization are important.
Example of a sheet used as a pelvic circumferential compression Compression Blunt Chest Trauma device
Image: “Use of a noninvasive pelvic circumferential compression Compression Blunt Chest Trauma device (PCCD) has become commonplace, and has become a well-established component of ATLS protocol” by Rahul Vaidya et al AL Amyloidosis. License: CC BY 4.0NYU Hospital for Joint Diseases algorithm for evaluation of a patient who presents to the emergency department with a suspected pelvic
fracture
Fracture
A fracture is a disruption of the cortex of any bone and periosteum and is commonly due to mechanical stress after an injury or accident. Open fractures due to trauma can be a medical emergency. Fractures are frequently associated with automobile accidents, workplace injuries, and trauma.
Overview of Bone Fractures
DPL
DPL
Washing out of the peritoneal cavity. The procedure is a diagnostic as well as a therapeutic technique following abdominal trauma or inflammation.
Penetrating Abdominal Injury:
diagnostic peritoneal lavage
Diagnostic peritoneal lavage
Washing out of the peritoneal cavity. The procedure is a diagnostic as well as a therapeutic technique following abdominal trauma or inflammation.
Penetrating Abdominal Injury
FAST: focused assessment with
sonography
Sonography
The visualization of deep structures of the body by recording the reflections or echoes of ultrasonic pulses directed into the tissues. Use of ultrasound for imaging or diagnostic purposes employs frequencies ranging from 1. 6 to 10 megahertz.
Diagnostic Procedures in Gynecology in trauma
SI: sacroiliac