Pelvic Fractures: Difference between revisions
No edit summary |
No edit summary |
||
| Line 12: | Line 12: | ||
== definition/description == | == definition/description == | ||
A pelvic fracture is a disruption of the bony structures of the pelvis. The pelvis consists of the ilium, ischium and pubis. These form an anatomic ring with the sacrum. Disruption of the ring requires a lot of energy. Because in most of the cases pelvic fractures are caused by high impact, it is possible that organs in the bony pelvis are affected. Trauma to extra-pelvic organs is common. They are often associated with severe hemorrhage due to the extensive blood supply to the region. <ref name="1">Mechemm C. C. et al, Pelvic Fracture in Emergency Medicine, medscape, may 2010 (level D)</ref><ref name="8">Tai D. K. C. et al, Retroperitoneal Pelvic Packing in the Management of Hemodynamically Unstable Pelvic Fractures: A Level I Trauma Center Experience, J Trauma. 2011;71: E79–E86 (level B)</ref> Pelvic fractures are associated with a high morbidity and mortality. Emergency care with primary aim reducing blood loss is always necessary. <ref name="7">Flint L., Cryer H. G., Pelvic Fracture: The Last 50 Years, The Journal of TRAUMA® Injury, Infection, and Critical Care, 2010, 69(3): 483–488 (level A1)</ref><ref name="10">Gruen G. S., Functional Outcome of Patients with Unstable Pelvic Ring Fractures Stabilized with Open Reduction and Internal Fixation, The Journal of Trauma: Injury, Infection, and Critical Care, 1995: 39(5) 838-845 (level B)</ref> | A pelvic fracture is a disruption of the bony structures of the pelvis. The pelvis consists of the ilium, ischium and pubis. These form an anatomic ring with the sacrum. Disruption of the ring requires a lot of energy. Because in most of the cases pelvic fractures are caused by high impact, it is possible that organs in the bony pelvis are affected. Trauma to extra-pelvic organs is common. They are often associated with severe hemorrhage due to the extensive blood supply to the region. <ref name="1">Mechemm C. C. et al, Pelvic Fracture in Emergency Medicine, medscape, may 2010 (level D)</ref><ref name="8">Tai D. K. C. et al, Retroperitoneal Pelvic Packing in the Management of Hemodynamically Unstable Pelvic Fractures: A Level I Trauma Center Experience, J Trauma. 2011;71: E79–E86 (level B)</ref> Pelvic fractures are associated with a high morbidity and mortality. Emergency care with primary aim reducing blood loss is always necessary. <ref name="7">Flint L., Cryer H. G., Pelvic Fracture: The Last 50 Years, The Journal of TRAUMA® Injury, Infection, and Critical Care, 2010, 69(3): 483–488 (level A1)</ref><ref name="10">Gruen G. S., Functional Outcome of Patients with Unstable Pelvic Ring Fractures Stabilized with Open Reduction and Internal Fixation, The Journal of Trauma: Injury, Infection, and Critical Care, 1995: 39(5) 838-845 (level B)</ref> | ||
<br>There are two classification systems who are used most commonly to describe pelvic fractures:<br>Classification of pelvic fractures by Tile is based on the integrity of the posterior sacroiliac complex. <ref name="2">Russel G. V. Et al, Pelvic Fractures, medscape, august 2011 (level D)</ref><ref name="10" /><br>• Type A: rotationally and vertically stable, the sacroiliac complex is intact. Mostly managed nonoperatively.<br>o A1: avulsion fractures<br>o A2: stable iliac wing fractures or minimally displaced pelvic ring fractures<br>o A3: transverse sacral or coccyx fractures<br>• Type B: rotationally unstable and vertically stable, caused by external or internal rotational forces, results in partial disruption of the posterior sacroiliac complex.<br>o B1: open-book injuries<br>o B2: LC injuries<br>o B3: bilateral type B injuries<br>• Type C: rotationally unstable and vertically unstable, complete disruption of the posterior sacroiliac complex, result of great force.<br>o C1: unilateral injury<br>o C2: bilateral injuries in which one side is a type B and the controlateral side is a type C injury<br>o C3: bilateral injury in which both sides are type C injuries | <br>There are two classification systems who are used most commonly to describe pelvic fractures:<br>Classification of pelvic fractures by Tile is based on the integrity of the posterior sacroiliac complex. <ref name="2">Russel G. V. Et al, Pelvic Fractures, medscape, august 2011 (level D)</ref><ref name="10" /><br>• Type A: rotationally and vertically stable, the sacroiliac complex is intact. Mostly managed nonoperatively.<br>o A1: avulsion fractures<br>o A2: stable iliac wing fractures or minimally displaced pelvic ring fractures<br>o A3: transverse sacral or coccyx fractures<br>• Type B: rotationally unstable and vertically stable, caused by external or internal rotational forces, results in partial disruption of the posterior sacroiliac complex.<br>o B1: open-book injuries<br>o B2: LC injuries<br>o B3: bilateral type B injuries<br>• Type C: rotationally unstable and vertically unstable, complete disruption of the posterior sacroiliac complex, result of great force.<br>o C1: unilateral injury<br>o C2: bilateral injuries in which one side is a type B and the controlateral side is a type C injury<br>o C3: bilateral injury in which both sides are type C injuries | ||
<br>Classification of pelvic fractures by Young and Burgess is based on mechanism of injury: lateral compression, anteroposterior compression, vertical shear or a combination of forces. <ref name="1" /><ref name="7" /><ref name="9" /><br>• Grade I: associated sacral compression on side of impact. Associated widening of pubic symphysis or of the anterior sacroiliac joint, while ligaments remain intact.<br>• Grade II: associated posterior iliac fracture on side of impact. Associated widening of the anterior SI joint caused by disruption of the anterior SI, sacrotuberous and sacrospinous ligaments, posterior ligaments remain intact.<br>• Grade III: associated controlateral sacroiliac joint injury. Complete SI joint disruption with lateral displacement and disrupted anterior SI, sacrotuberous, sacrospinous and posterior SI ligaments. | <br>Classification of pelvic fractures by Young and Burgess is based on mechanism of injury: lateral compression, anteroposterior compression, vertical shear or a combination of forces. <ref name="1" /><ref name="7" /><ref name="9">Guthrie H. C. et al, Focus On Pelvic Fractures, the journal of bone and joint surgery, 2010 (level D)</ref><br>• Grade I: associated sacral compression on side of impact. Associated widening of pubic symphysis or of the anterior sacroiliac joint, while ligaments remain intact.<br>• Grade II: associated posterior iliac fracture on side of impact. Associated widening of the anterior SI joint caused by disruption of the anterior SI, sacrotuberous and sacrospinous ligaments, posterior ligaments remain intact.<br>• Grade III: associated controlateral sacroiliac joint injury. Complete SI joint disruption with lateral displacement and disrupted anterior SI, sacrotuberous, sacrospinous and posterior SI ligaments. | ||
== Mechanism of Injury / Pathological Process<br> == | == Mechanism of Injury / Pathological Process<br> == | ||
Revision as of 21:23, 20 December 2011
Be the first to edit this page and have your name permanently included as the original editor, see the editing pages tutorial for help.
|
Original Editor - Your name will be added here if you created the original content for this page. Lead Editors - Your name will be added here if you are a lead editor on this page. Read more. |
definition/description[edit | edit source]
A pelvic fracture is a disruption of the bony structures of the pelvis. The pelvis consists of the ilium, ischium and pubis. These form an anatomic ring with the sacrum. Disruption of the ring requires a lot of energy. Because in most of the cases pelvic fractures are caused by high impact, it is possible that organs in the bony pelvis are affected. Trauma to extra-pelvic organs is common. They are often associated with severe hemorrhage due to the extensive blood supply to the region. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Pelvic fractures are associated with a high morbidity and mortality. Emergency care with primary aim reducing blood loss is always necessary. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
There are two classification systems who are used most commonly to describe pelvic fractures:
Classification of pelvic fractures by Tile is based on the integrity of the posterior sacroiliac complex. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
• Type A: rotationally and vertically stable, the sacroiliac complex is intact. Mostly managed nonoperatively.
o A1: avulsion fractures
o A2: stable iliac wing fractures or minimally displaced pelvic ring fractures
o A3: transverse sacral or coccyx fractures
• Type B: rotationally unstable and vertically stable, caused by external or internal rotational forces, results in partial disruption of the posterior sacroiliac complex.
o B1: open-book injuries
o B2: LC injuries
o B3: bilateral type B injuries
• Type C: rotationally unstable and vertically unstable, complete disruption of the posterior sacroiliac complex, result of great force.
o C1: unilateral injury
o C2: bilateral injuries in which one side is a type B and the controlateral side is a type C injury
o C3: bilateral injury in which both sides are type C injuries
Classification of pelvic fractures by Young and Burgess is based on mechanism of injury: lateral compression, anteroposterior compression, vertical shear or a combination of forces. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
• Grade I: associated sacral compression on side of impact. Associated widening of pubic symphysis or of the anterior sacroiliac joint, while ligaments remain intact.
• Grade II: associated posterior iliac fracture on side of impact. Associated widening of the anterior SI joint caused by disruption of the anterior SI, sacrotuberous and sacrospinous ligaments, posterior ligaments remain intact.
• Grade III: associated controlateral sacroiliac joint injury. Complete SI joint disruption with lateral displacement and disrupted anterior SI, sacrotuberous, sacrospinous and posterior SI ligaments.
Mechanism of Injury / Pathological Process
[edit | edit source]
add text here relating to the mechanism of injury and/or pathology of the condition
Clinical Presentation[edit | edit source]
add text here relating to the clinical presentation of the condition
Diagnostic Procedures[edit | edit source]
add text here relating to diagnostic tests for the condition
Outcome Measures[edit | edit source]
add links to outcome measures here (see Outcome Measures Database)
Management / Interventions
[edit | edit source]
add text here relating to management approaches to the condition
Differential Diagnosis
[edit | edit source]
add text here relating to the differential diagnosis of this condition
Key Evidence[edit | edit source]
add text here relating to key evidence with regards to any of the above headings
Resources
[edit | edit source]
add appropriate resources here
Case Studies[edit | edit source]
add links to case studies here (case studies should be added on new pages using the case study template)
References[edit | edit source]
References will automatically be added here, see adding references tutorial.
