- Discussion: Anterior Lesion:
-
lateral compression injury, contralateral type (Bucket Handle):
- bucket handle type of injury is usually caused by direct blow to pelvis;
- anterior fracture may be on the opposite side to the posterior lesion
(contralateral type) or all four rami may fracture anteriorly;
- anterior lesion may involve disruption of only one contra-lateral
pubic ramus, all 4 rami or two contra-lateral rami & symphysis pubis;
- another combination is symphysis disruption with two rami frx;
- affected hemipelvis rotates anteriorly & superiorly like handle of bucket;
- affected hemi pelvis rotates internally upto 40 deg;
- this particlar type may cause a rotatory deformity of the hemipelvis as
well as a leg length descrepancy;
- Posterior Lesion:
- lateral compressive force applied to ilium results in anterior
SI complex
injury (or
sacral frx) one side & displacement of anterior hemipelvis
on opposite side;
- hemipelvis rotates internally, but vertical displacement is prevented by
intact sacrospinous and sacrotuberous ligaments;
- Management:
- reduction requires derotation of hemipelvis rather than traction in vertical plane;
- this frx remains stable, esp to external rotation & vertical movement, because
sacrotuberous and sacrospinous ligaments remain intact;
- because pelvis is pushed inward, instability is in internal rotation;
- to overcome this, hemipelvis must be placed in external rotation;
- since tension bands are intact, reduction will not be overcorrected;
- closed reduction of a lateral compession type injury is performed
by external rotation of the hip with the knee flexed and direct
pressure on the hemipelvis using flouroscopy;
- surgical stabilization is rarely indicated, unless reduction is necessary to
correct leg length discrepancy of greater than 2.5 cm;
-
external fixation may be indicated in this case;
- Post Op Care:
- external fixation frame is left on until union is seen in about three months;
- wt bearing is commenced on uninvolved posterior side once pt is comfortable;
- on involved side, weight bearing should be limited for six weeks;
