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Pelvic Traumatology , Fractures

Pelvic Traumatology , Fractures. Dr Bakhtyar Baram. Epidemiology. Pelvis is normally very stabil but not in the osteoporotic pt.s . Normally need ahigh force to make afracture like traffic accidents and fall from high .

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Pelvic Traumatology , Fractures

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  1. PelvicTraumatology, Fractures Dr BakhtyarBaram

  2. Epidemiology • Pelvis is normallyvery stabil but not in the osteoporoticpt.s. • Normallyneedahigh force to makeafractureliketrafficaccidents and fall from high. • Veryclose to other organs, lead to leasion of the other organs. • May beaccompanied with otherleasions–multitrauma pt. S- • Otherfractures 85% • Lung 60% • CNS 40% • Abdomen 30% • UTS 12% • Cardiovascular 6% • Pelvicfractures is about 3% of all fractures. • In Europa about 30/100 000/year.

  3. Isolatedpartialfractures • Partial small fractures in the pelvisoccure most in the children and youngadults and mostly the tendon of one of the muscelswillmakeasmallfracture in it s origion.likesartoriusmakespinailiacaant. Sup., rectusfemoris to spinailiacaant. Inf., pubisramisinf. With adduc. Longus ….etc • Clinically the pt has pain and localtenderness, • Normallynoneed for anyspecialtreatment, bed rest and analgesicmaybeenough. • When the callus start , the x-raylooklike metastase tumor. • Marginal fracture in Ilium bone occure most in osteoporoticpt.sor in the ramuspubisinf or sup or bothwhichnoneed for anyspecialtreatment, needearlymobilization and analgesic with non wight-bearing for 2-3 weeks.

  4. Pelvic ring fractures • The pelvis is composed of 2 symettric parts , dislocation of that ring needa high energy power and normally will accompanied with other fractures in the pelvis, trauma mechanism is associated with the classification and the treatment. • Classified to type A, B, C .

  5. Type A , Anteroposteriorcompression-APC- • A1: fracturewithoutinvolving dobbelt ring. • A2: stabil minimal dislocated.diastasis more marcked, maybeslight separation of of SI joint but still satbil • A3,APC 3, the ant and post. SI ligaments aretorn,CT show separation of the joint,unstabil.

  6. Type-Lateral compression-LC1 or B1 is normally stabile when the fracture occur in symphysis but there is not any dislocation posteriorly.But in type B2- can be stabile or unstable depending on the character, i.e. sacrum fracture or sacroiliac dislocation,B3 is unsabil or LC3 injuries, which cause an opposite force on the opposite illium .type C or vertical shear in which the hemi pelvis is totally disconnected , is unstable , involving ligament lesions,

  7. Examination • History is important. • Clinically , swelling, skin changes, hematomas, open fractures, testing stability by palpation, find any tenderness, lower extremities, neurovascular changes, exam. Of testes,urethral meatus, abdomen and other regions. • Normal x-ray of pelvis is indicated in all multitrauma pt. 30 degree x-ray from each side may be indicated. • CT or MRI is useful in these cases or indicated.

  8. Evaluation and primary treatment. • Dislocated pelvic fractures has a high risk of mortality to over 50%. • Development in treating multitraumapt.sdecreaset that rate, like ATLS and etc. • The cause of that high mortality , most of them is multitrauma pt. s and have other organ injuries and because of the bleeding which is uncontrolled. • It cause normally retroperitoneal bleeding from the vein plexuses or arteries,a. glutea sup. , a. internailiaca, or obturatera..,with open ring fractures the capacity of the pelvis for containing of the bleeding will increase. • Fixing , or applying a pelvic binder, to achieve side to side compression is indicated to reduce the pelvic volume. • Acute open operation to ligate the vessels may be indicated with internal fixation of the pelvis. • Primary resuscitation is necessary and may be indication for involving of other specialties , urogenital, abdominal, cardiovascular etc • Ultra sound exam. In the emergincy unit , CT or MRI will show the bleeding, rectum, úrethra vagina and periniumleasions, • If there is sign of urethral tear , suprapubic cathetrization will be indicated .bladder wall injuries, repair and all other urogenital operations will be done with the first operation

  9. In the stabilundislocated fractures without ligament tears can conservative treatment be used, , short bed rest with early mobilization will be effective with analgesics. • In sever unstabil fractures will be depending on the other organ leasions but the reconstruction of the pelvis is best to be done with the other pelbic and abdominal operations. • Types of fixation • External fixation which putts in ant. Cresta,it will give agood stability, espicially with ant. Tears and can be used as permanent treatment.or can be used with other horizental fractures.it is easy and can be applied even in the small hospitals before transferring the pt to an other large hospital.2-3 pins in each side. • Internal fixation may be, screw, fixation of symphesis .plate on illium or ant-post. Fixation of SI joint.

  10. complications • Thromoembolism • Sciatic or other nerve injury. • Urogenital problems, stricture, incontionence, impotence. • Chronicsacroilliacpain.

  11. thanks

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