Normal findings AP View Interpretation Summary Radiographic interpretation is systematized with ABCS approach: When the fracture is noted in the AP view, special views (inlet and outlet view and oblique views) for further investigations are recommended. The routine pelvic view is anteroposterior (AP) projection, and in 94% of cases, a correct diagnosis can be made from this view. A combination of injuries results in a complex radiological picture. The pelvis is exposed to two or more of the forces mentioned above. Complex pattern happens in less than 25% of cases.Vertical shear forces the hemi-pelvis upwards and towards the midline and can tear all the sacroiliac ligaments on the affected side as well as the pubic symphysis ligaments.A lateral compression force can also impinge on the upper femur causing central dislocation of the hip. Lateral compression produces a horizontal fracture through the ipsilateral pubic symphysis and momentary medial displacement of the hemipelvis.An anteroposterior force can also push the flexed femur backward so that the femoral head impacts and fractures the posterior margin of the acetabular rim. For the pubic bones to separate by over 2,5 cm, one or both of the ligaments associated with sacroiliac joints have to be torn. A diffuse force will disrupt the pubic symphysis, while a more direct force fractures the pubic rami in a vertical plane. Anteroposterior compression causes “open book” look at one or both sides of the pelvis.
The Young-Burgess system identifies four types of pelvic ring disruption, based on interpretation of radiographic images: anteroposterior compression, lateral compression, vertical shear and combined mechanical injury.
If bones fracture but the ligaments remain intact, a tamponade effect can be achieved, and the degree of hemorrhage limited. The bleeding is usually venous and extraperitoneal and can be life-threatening. In this situation, the nerves and vessels running close to them, especially at the posterior, can also be injured. Torn or rupture of the ligaments can cause separation of three bones. The urethra and bladder lie close to the pubic symphysis, and there is a 20% risk of injury if symphysis is disrupted. However, adds little to the overall stability of the pelvis.
The pubic symphysis, a fibrocartilagenous joint, is supported by ligaments. Two ligaments originate from the side and back of the sacrum and insert into the ischial spine and ischial tuberosity. A large array of ligaments traverses the interior and exterior surface of the posterior aspect of the pelvis. These are crucial for maintaining pelvic stability. Strong ligaments keep these three bones together. The three bones compose the pelvis (the sacrum and the two innominate bones). You placed a pelvic binder and ordered a pelvic X-ray.
During the secondary survey, pelvic bones are not stable, and there is a pain on palpation. She is hemodynamically stable with vital signs as follows: temperature of 36.4☌, heart rate of 70 bpm, blood pressure 120/80 mmHg, respiratory rate 10/min, oxygen saturation 99% on room air. Case PresentationĪ 27-year-old woman was in a car accident. Patients who survive a pelvic fracture are at risk for significant complications such as chronic pain, leg length discrepancy, sexual dysfunction, or nerve palsy. Isolated ring fractures, however, tend to be stable. If the pelvic ring is broken in two places, the fracture is likely to be unstable. Fractures may be associated with vascular, soft tissue and visceral injuries. Usually, injuries are secondary to massive force, such as a road traffic accident or fall from a height. The mortality from pelvic fractures in patients who reach hospital is reported to be between 7.6% and 19%. The prevalence of pelvic fracture in studies of patients with blunt trauma is between 5% and 11.9%. Pelvic fractures carry life‐threatening injury potential which should be identified or suspect during the primary assessment of patients with major trauma. By Sara Nikolić and Gregor Prosen Introduction