See also: X-rays for THR X-rays for Femoral Neck Fractures Discussion this view should demonstrate the iliac bone, sacrum, pubis, ischium, femoral heads and necks, and greater or lesser trochanters; arcuate, iliopubic, ilioischial, and acetabular teardrop lines, sacral foramina, & SI joint should be scrutinized carefully and identified in a systematic manner; patient is supine with the … Read more
– Discussion: – anterior SI ligaments are stretched; – radiographs show slight (< 2 cm) widening of the pubic symphysis and often imperceptable widening of the SI joint; – results from low energy forces Surgeon Variability in the Treatment of Pelvic Ring Injuries Stress radiograph to detect true extent of … Read more
Indications allows unobstructed view of articular surface of acetabulum; Technique proximal bolt is inserted in the iliac wing in its superior portion, just distal to thickened crest; proximal bolt must pass through portion of ilium in continuity w/ sacrum (or frx proximal to this point must be stabilized) prior to application of a distraction force; distal bolt … Read more
– Discussion: – usually involves a supination-adduction injury; – frequently does well w/ closed reduction; – if frx in fibula is transverse, it is type I avulsion fibular frx; – since syndesmotic ligaments are intact, ankle mortise is also stable; – type A: fibula fracture … Read more
– See: Smith Peterson Approach – Discussion: – major problems with the Watson Jones technique are dealing w/ gluteus medius & minimus, which lie over anteior capsule and must be damaged or cut to obtain adequate exposure; – original Charnely technique used anterolateral approach w/ pt supine, osteotomy of greater troch, … Read more
– Seee: Anterior Pelvic Injuries – Discussion: – symphyseal diastasis and/or longitudinal rami fractures; – these injuries result from relatively anterior or posterior forces applied to the anterior or posterior superior iliac spine areas; – this gives rise to forces that tend to disrupt anterior pelvis, either by fracturing … Read more
– Discussion: – anterior wall frx involve central portion of anterior column & involves iliopectineal line is involved; – associated injury: anterior hip dislocation; – Technique of Fixation: – anterior wall fractures are approached thru Ilioinguinal Approach w/ supine positioning; – traction removes femoral head from the … Read more
– Two Hole Implants: – two hole plate, usually a 4.5 mm, is fixed to the superior surface of the symphysis with two 6.5 mm cancellous screws immediately adjacent to the symphysis pubis; – screws are inserted on the anterosuperior surface of the pubis on either side of the symphysis … Read more
– Discussion: – anterior injury may be through symphysis or thru pubic rami unilaterally or bilaterally; – symphysis disruption may also occur with pubic rami fractures; – posterior injury: degree of SI joint disruption depends on the energy sustained during the trauma; … Read more
– See: Anterior Plate Fixation Methods – Indications: – open book pelvis injury w/ greater than a 2.5 cm pubic diastasis; – note that fixation of pubic rami fractures can be much more complex than the fixation of a simple diastasis; – controversies: – posterior injury and need for … Read more