- Discussion:
- classified pelvic ring injuries simply according to site of injury;
- anterior disruption can occur thru either pubic symphysis or pubic rami;
- injury may be through the ilium, the
SI joint, or the sacrum;
- it can involve frx-dislocation of SI joint, which commonly involves frx thru most posterior portion of iliac wing that crosses joint;
- frx line leaves a portion of ilium in its nl position, articulating w/ upper portion of the SI joint;
- more anterior portion of the ilium dislocates from lower
SI joint;
- acetabular fracture is another possible site of pelvic ring disruption;
-
classification: includes ten fracture types subdivided by 5 simple frx and 5 combined frx patterns;
-
5 simple frx types: account for about 20% of acetabular frx;
-
posterior wall;
- posterior wall frxs always involve posterior articular surfaces, often accompanied by a portion of the
retroacetabular surface and sometimes the entire surface;
- ilioischial line remains intact;
-
posterior column;
- bony strut running from PSIS to inferior pubic ramus, & includes posterior wall;
- involves not only the posterior articular surfaces, but also the ilioischial line;
-
anterior wall
-
anterior column;
- bony strut running from ASIS to superior pubic ramus, & includes
Anterior wall;
- iliopectineal line is involved;
-
transverse frx;
- involve both anterior & posterior acetabulum: dividing the innominate bone into superior segment containing
acetabular roof & intact ilium, & inferior segment consisting of single ischiopubic fragment;
-
5 combined frx types:
- discussion:
- account for about 80% of acetabular frx;
- are composed of two or more of the elementary fracture patterns;
- many assoc frx types, esp
two-column frx, require more extensive exposures than are achieved by either
ilioinguinal or
posterolateral approach alone;
- frx types:
-
posterior wall & post column frx
-
posterior wall and
transverse frx
-
t-shaped fracture
- common associated frx type (about 35% of acetabular frx);
- combines a transverse component & vertical component that separates the lower ischiopubic
segment into the anterior and posterior columns.
-
anterior and posterior hemitransverse frx,
- anterior column or
anterior wall predominating in displacement;
- low and usually minimally displaced posterior hemitransverse component is present;
-
both column frx
- all segments of the articular surface are detached from the ilium;
- Radiographs: classfication is based on 3 x-ray views;
-
AP view;
-
Obturator view;
-
Iliac view;
Letournel Classification for Acetabular Fractures. Assessment of Interobserver and Intraobserver Reliability.
