APC III

- 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;
    - references: Radiological analysis, operative management and functional outcome of open book pelvic lesions: a 13-year cohort study.

- Anterior Fixation Methods:
      - anterior fixation alone is indicated for type II fractures, where as type III require anterior fixation along with posterior fixation;
      - treatment options:
            - Orthomed pelvic reduction clamps (temporary for reduction of pelvic volume)
            - External Fixation:
                    - indicated for SI diastasis or pubic ramus frx which cannot be treated by open reduction or screw fixation;
                    - such as may occur w/ suprapubic cystostomy tube or open frx;
           - Open Reduction and Plate Fixation:
                   - types of anterior plates
                   - indicated for pubic diastasis greater than 2.5 cm;
           - Retrograde Medullary Superior Ramus Screw:
                   - indicated for superior ramus fractures which occur along w/ an ustable posterior injury


Pelvic fracture in multiple trauma: classification by mechanism is key to pattern of organ injury, resuscitative requirements, and outcome.



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Tuesday, September 27, 2016 12:07 pm