1. Common adult fractures Axial skeleton (Pelvis) Waleed M. Awwad, MD. FRCSC Assistant professor and Consultant Orthopedic Surgery department

2. Pelvic fractures

3. Epidemiology 37 cases per 100,000 / year at USA. Age: – Young: high energy mechanisms. – Elderly: minimal trauma. Male are more commonly affected before the age of 35. 37 cases per 100,000 / year at USA. Age: – Young: high energy mechanisms. – Elderly: minimal trauma. Male are more commonly affected before the age of 35.

4. Anatomy

5. Anatomy

6. Anatomy

7. Anatomy

8. Pelvic stability Rotational or vertical. – Sacroiliac displacement 5mm. – Posterior fracture gap. – Symphysis diastasis. Specific injury pattern (direction of force): – AP  external rotation of hemipelvis, spring open. – LC (T-bone): Posterior half of ilium. Anterior half of iliac wing. Greater trochanteric region. External rotation and abduction, shear forces.

9. Pelvic fracture patterns.

10. Assessment ABCDE’s must be assessed first and treated appropriately. Patients should be examined with spinal collar until spinal pathology is excluded. Careful log rolling keeping the head, neck and pelvis in line should be done to examine the spine properly. Pelvic stability test (AP-LC only once). Massive flank or buttock contusion. Palpation of posterior aspect, symphysis and perineum. Digital rectal and vaginal exam in any pelvic ring fractures. ABCDE’s must be assessed first and treated appropriately. Patients should be examined with spinal collar until spinal pathology is excluded. Careful log rolling keeping the head, neck and pelvis in line should be done to examine the spine properly. Pelvic stability test (AP-LC only once). Massive flank or buttock contusion. Palpation of posterior aspect, symphysis and perineum. Digital rectal and vaginal exam in any pelvic ring fractures.

11. Assessment Hemodynamic status: – Usual cause of retroperitoneal hemorrhage is venous. – Arterial bleeding: Small vessels: embolization Large vessels: immediate surgical exploration. At emergency: open book pelvic fracture. – Pelvic wrapping at the level of GT. Hemodynamic status: – Usual cause of retroperitoneal hemorrhage is venous. – Arterial bleeding: Small vessels: embolization Large vessels: immediate surgical exploration. At emergency: open book pelvic fracture. – Pelvic wrapping at the level of GT.

12. Assessment

13. Assessment

14. Associated injuries Neurological: Lumbosacral plexus and nerve root. Genitourinary: – Bladder: 20% incidence. Extraperitoneal: foley if unable to pass. Intraperitoneal: surgical repair. – Urethral:10% incidence. male > females. Blood at meatus or catheterization, high ridding prostate. Any clinical suspicion  retrograde urethrogram. Bowel: perforation (open injury), rarely entrapment. Diverting colostomy.

15. Radiographic evaluation AP pelvic view. Inlet and outlet views. Obturator and iliac oblique views if acetabular fracture. Computed tomography. MRI (limited clinical utility).

16. Radiographic evaluation

17. Management Depend on severity and stability.

18. Management If stabile: protected weight bearing and serial X-rays. If unstable: – External fixation. – Internal fixation. Absolute surgical indication: – Open pelvic fractures. – Open book pelvic fracture or vertical unstable.

19. Acetabulum 3 per 100,000 population / year. Neurological injury up to 30% (peroneal division more than tibial). Components: – Anterior and posterior column. – Acetabular dome (weight bearing area).

20. Radiological Obturator and iliac oblique views: – Iliac oblique: posterior column, iliac wing and anterior wall of the acetabulum. – Obturator oblique: anterior column and posterior wall of the acetabulum.

21. Radiological

22. Classification

23. Management Goal of treatment is anatomic restoration of articular surface to prevent post traumatic arthritis. Non operative treatment: – Non displaced fracture or less than 2mm displacement. – Less than 20% posterior wall fracture. Surgical treatment: – Displacement >2mm. – Large posterior wall fragment. – Intra-articular fragment. – Irreducible fracture dislocation. – Posterior instability.

24. Questions