- See:
Pelvic Fractures:
- Discussion:
- most common form of pelvic fracture;
- transverse frx of pubic rami & ipsilateral / contralateral to posterior injury;
- LC injuries are described by both their anterior and posterior pathology;
- w/ LC injuries, pelvic ring implodes or collapses, & one side rotates medially toward and occassionally beyond
midline, usually on a posteriorly based perpendicular axis;
- often these have rotational instability, with verticle stability;
- usually the sacrotuberous and sacrospinous ligaments are intact;
- transverse frx of at least one set of pubic rami;
- 4 subsets: of anterior ring;
- unilateral pubic rami frx (superior and inferior);
- unilateral rami frx w/ symphysis injury;
- bilateral rami frx (all 4 rami frx'ed)
- bilateral rami frx with pubic symphysis injury;
- associated injuries:
-
vascular injuries:
- occassionally LC frx may
result in major hemorrhage if one of fracture fragments directly tears one of the
larger vessels of the pelvis;
- Classification:
-
LC-I
-
sacral compression frx on side of impact;
- least destructive lateral compression injury;
- not unstable, because even sacral frx is impacted;
- stable lateral compression injury, in which tension bands are intact;
-
LC-II
- crescent (
iliac wing) frx on side of impact;
- w/ increasing lateral force, usually imparted to the anterior pelvis, major frx frag is rotated inward,
w/ anterior sacrum acting as pivot;
- this gives rise to either a portion of iliac wing to hinge outwards, or to an oblique fracture of posterior ileum,
usually extending laterally from the
sacroiliac joint;
-
LC-III
-
LC-1 or
LC-II injury on side of impact + contra-lateral
APC injury;
- most severe form of lateral compression is severely unstable;
- lateral compressive force on one side of pelvis continues to contralateral side where it becomes distracting force,
externally rotating anterior pelvis;
- Management:
- in lateral compression injuries the pelvis is pushed inward;
- consequently, the instability is in internal rotation.
- to overcome this, the hemipelvis must be placed in external rotation;
- in a stable lateral compression injury, in which tension bands are intact, it is unlikely that the reduction will be overcorrected;
- in some cases, the fracture reduces in the supine position;
- in some cases, the reduction can be held with a K wire across the symphysis, which holds it in position for 6-8 weeks;
- in other cases, a
external fixator is required to distract open the pelvic wings;
- when using an external fixator for LC injuries, use flouro to monitor the effect that anterior distraction has
on the posterior compression injury;
- if the posterior injury becomes disimpacted, the injury may become unstable;
- in the report by C. Bellabarba et al 2000, the authors report on 14 consectutive vertically stable lateral compression frxs;
- these patients underwent closed reduction and maintenance of the distraction force with a two pin single bar
external fixator (supra-acetabular external fixator) followed by immediate wt bearing;
- pins were inserted directly through the anterior inferior spines;
- the authors note that all fourteen patients achieved a symmetric reduction;
- time to healing was about two months;
- there were no neurologic injuries occuring from the reduction;
Lateral compression fractures of the pelvis: the importance of plain radiographs in the diagnosis and surgical management.
The Unstable Pelvic Fracture: Operative Treatment. JF Kellum MD, RY McMurty MD, D. Paley MD, and M. Tile MD.
Orthopaedic Clinics of North America. Vol 18. No 1, Jan 1987. p 25.
Distraction external fixation in lateral compression pelvic fractures.
Carlo Bellabarba et al.
Journal of Orthopaedic Trauma. Vol 14. No 7. p 475-482.
Distraction external fixation in lateral compression pelvic fractures.
Distraction External Fixation in Lateral Compression Pelvic Fractures.
