- See:
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 pubic rami or by rupturing ligaments of symphysis pubis;
-
classification:
-
APC-I
- slight widening of pubic symphysis and/or anterior
SI joint
- stretched but intact anterior SI, sacrotuberous, & sacrospinous ligaments,intact posterior
SI ligaments;
-
APC II
- widened anterior SI joint; disrupted anterior SI, sacrotuberous, and sacrospinous ligaments, intact posterior
SI ligaments;
- continued AP forces tend to cause splaying of anterior pelvis, w/ external rotation of iliac wings swinging open at posterior aspect of SI joints
resulting in a type II frx;
-
APC III
- complete SI joint disruption with lateral displacement;
- disrupted anterior SI , sacrotuberous, and sacrospinous lig;
- disrupted posterior
SI ligaments;
-
AO type b1 (open book injury - external rotation);
- injury is caused by an external rotational force which disrupts the symphysis pubis and causes the pelvis to open like a book;
- hemipelvis is unstable in external rotation, the end point is reached when posterior superior iliac spine abuts against sacrum;
- in this particular injury, posterior ligamentous structures remain intact so no vertical instability is possible;
- lesion may be unilateral or bilateral;
- if symphysis pubis is open < 2.5 cm, only symphysis is disrupted but not sacrospinous or anterior sacroiliac ligaments;
- if the symphysis is open more than 2.5 cm there is disruption of the sacrospinous and anterior sacroiliac ligaments;
-
stability:
- depends on integrity of various ligaments involved;
- division of symphysis allows approx 2.5 cm of diastasis of symphysis;
- additional division of anterior sacroiliac, sacrospinous, & sacrotuberous ligaments allows further diastasis (causing
type II)
- complete instability is not achieved until all of sacroiliac ligaments are disrupted (
type III);
- Management:
- this injury is stabilized by reducing anterior symphyseal diastasis;
-
external pelvic fixator:
- this maneuver uses intact posterior
SI ligaments as tension band and is best accomplished w/
external pelvic fixator;
-
hemmorhage:
- hemmorhage is directly linked to close proximity of internal iliac vessels & anterior
SI ligaments, which are disrupted in open book injuries;
-
angiographic embolization is indicated only if pt is hemodynamically unstable after pelvic reduction;
- closed techniques:
- pelvic sling is applied around the greater trochanters and the symphysis pubis
- tensioned to 180 N;
- references:
-
Noninvasive reduction of open-book pelvic fractures by circumferential compression.
- Emergent Management of Pelvic Ring Fractures with Use of Circumferential Compression. Michael Bottlang, PhD et al. JBJS 84:S43-S47 (2002)
- Unstable pelvic ring disruptions in unstable patients. Kregor PJ, Routt ML Jr. Injury, 1999;30(Suppl 2): 19-28
-
A rational approach to pelvic trauma. Resuscitation and early definitive stabilization.
-
Prehospital stabilization of pelvic dislocations: a new strap belt to provide temporary hemodynamic stabilization.
-
Stabilization of pelvic ring disruptions with a circumferential sheet.
-
The antishock pelvic clamp.
-
Pressure-volume characteristics of the intact and disrupted pelvic retroperitoneum.
The long-term results of nonoperatively treated major pelvic disruptions.
Our results of surgical management of unstable pelvic ring injuries
