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Pelvic Ring Injury

 
ICD-9 Classification / Treatment
Etiology / Natural History Associated Injuries / DDx
Anatomy Complications
Clinical Evaluation Follow-up Care
Xray / Diagnositc Tests Review References

synonyms:

Pelvic Ring Injury ICD-9

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Pelvic Ring Injury Etiology / Epidemiology / Natural History

  • Head injury isost common cause of death for lateral compression fractures.  Anteroposterior compression injury =  combined pelvic and visceral injury.

Pelvic Ring Injury Anatomy

  • Fracture of the lateral sacrum or avulsion of the sacrospinous and sacrotuberous ligaments indicates  anteroposterior compression-type pelvic ring injuries are unstable.

Pelvic Ring Injury Clinical Evaluation

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Pelvic Ring Injury Xray / Diagnositc Tests

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Pelvic Ring Injury Classification / Treatment

  • Consider pelvic orthotic devices or binders (bed sheet) placed at the level of the greater trochanters. (Krieg JC, J Trauma 2005;59(3):659-664).
  • Anteroposterior Compression / Open book pelvic ring injury; hemodynamically unstable (hypotension, tachycardia): immediate application of a sheet or binder along with resuscitation. Consider emergent external fixation, pelvic packing, or angiography if unresponsive to pelvic binder. Operative repair of the pubic symphysis is indicated after patient is fully resuscitated and stable. (Krieg JC, J Trauma. 2005;59:659). Most common cause of mortality is combined pelvic and visceral injury.
  • Anteroposterior Compression / Open book pelvic ring injury without disruption of the posterior ligamentous constraints; hemodynamically stable (APC Grade II): ORIF with multi-hole plate. (Sagi HC JOT. 2008 Jul;22:373).
  • Anteroposterior Compression / Open book pelvic ring injury with disruption of the posterior ligamentous constraints; hemodynamically stable (APC Grade III): ORIF with multi-hole plate and posterior screw fixation
  • Lateral Compression Injury: Most common cause of death is closed head injury.
  • Tilt fracture = lateral compression pelvic ring injury with a displaced superior ramus fracture. More common in female patients.  Vaginal examination required to rule out open fracture.
  • Anterior-posterior compression (APC) injuries: external rotational pelvic instability. More likely to be associated with solid and hollow abdominal organ injury, more profound shock, sepsis, and delayed respiratory distress syndrome. Transfusion volume and mortality are highest.
  • Lateral compression (LC) injuries: internal rotation of the hemipelvis; higher associated incidence of traumatic brain injury
  • Vertical shear (VS) injuries: vertical instability and displacement
  • Combined mechanism (CM) injuries: have components of the other three patterns.  

Pelvic Ring Injury Associated Injuries / Differential Diagnosis

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Pelvic Ring Injury Complications

Pelvic Ring Injury Follow-up Care

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Pelvic Ring Injury Review References

  • Krieg JC, Mohr M, Ellis TJ, Simpson TS, Madey SM, Bottlang M. Emergent stabilization of pelvic ring injuries by controlled circumferential compression: a clinical trial. J Trauma. 2005 Sep;59(3):659-64.
  • Croce MA, Magnotti LJ, Savage SA, Wood GW 2nd, Fabian TC. Emergent pelvic fixation in patients with exsanguinating pelvic fractures. J Am Coll Surg. 2007 May;204(5):935-9
  • Routt ML Jr, Falicov A, Woodhouse E, Schildhauer TA. Circumferential pelvic antishock sheeting: a temporary resuscitation aid. J Orthop Trauma. 2002 Jan;16(1):45-8
  • Burgess AR, Eastridge BJ, Young JW, Ellison TS, Ellison PS Jr, Poka A, Bathon GH, Brumback RJ. Pelvic ring disruptions: effective classification system and treatment protocols. J Trauma. 1990 Jul;30(7):848-56.
  • Lefaivre KA, Padalecki JR, Starr AJ. What constitutes a Young and Burgess lateral compression-I (OTA 61-B2) pelvic ring disruption? A description of computed tomography-based fracture anatomy and associated injuries. J Orthop Trauma. 2009 Jan;23(1):16-21.
  • Koo H, Leveridge M, Thompson C, Zdero R, Bhandari M, Kreder HJ, Stephen D, McKee MD, Schemitsch EH. Interobserver reliability of the Young-Burgess and Tile classification systems for fractures of the pelvic ring. J Orthop Trauma. 2008 Jul;22(6):379-84.
  • Tile M. Acute Pelvic Fractures: I. Causation and classification. J Am Acad Orthop Surg. 1996 May;4(3):143-151.
  • Sagi HC, Papp S. Comparative radiographic and clinical outcome of two-hole and multi-hole symphyseal plating. J Orthop Trauma. 2008 Jul;22(6):373-8

 

 

 

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