- Discussion:
- involves tearing of both anterior
SI ligaments of floor of pelvis
(sacrotuberous and sacrospinous);
- involves a widened anterior
SI joint
& injury to anterior ring (usually a
symphysis diastasis) best seen on the
Inlet view;
- may be bilateral or unilateral;
- this is a true open book injuries w/ splaying of anterior pelvis:
- anterior constraint (anterior bony ring & sacrospinous, sacrotuberous,
& anterior
SI ligaments) are torn, leaving intact only the posterior
SI ligaments (which serve as the binding of the book);
- Assessment of Stability:
- isolated division of symphysis pubis allows approx 2.5 cm of diastasis
of symphysis pubis;
- further division of anterior
sacroiliac, sacrospinous, & sacrotuberous
ligaments causes further instability (APC II), but complete instability does
not occur until all of
sacroiliac ligaments are disrupted (
Type III);
- Sequelae:
- this type of injury leaves the pelvis unstable to external rotation;
- may produce significant
neural and
arterial complications;
- Management:
-
External Fixation:
- consider anterior external frame;
- pins should remain in place for approx 6-8 weeks;
