- Discusison:
- w/ application of severe AP force, hemipelvis rotates externally until posterior iliac wing contacts posteior sacrum;
- continued force rips posterior
SI ligaments, completely dissconecting hemipelvis from the sacrum;
- APC III have highest rate of assoc injury, including
retroperitoneal bleeding;
- by definition then, an APC III injury shows destruction of all the ligamentous constraints connecting the involved side of the
hemipelvis to the axial skeleton and the opposite hemipelvis;
- these types of fractures are associated with
vascular injury;
- 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);
- Radiology:
- Push-Pull Views:
- used to evaluate dynamic displacement of the pelvis;
- these views are obtained as in
Outlet view w/ examiner pushing on the femur for one view and pulling on it for other;
Pelvic fracture in multiple trauma: classification by mechanism is key to pattern of organ injury, resuscitative requirements, and outcome.
