Fractures and Dislocations of the Pelvis

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Fractures and Dislocations of the Pelvis
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Sacral Fractures

• Usually from fall or direct trauma 2 types
• Horizontal(transverse) fxs.- m.c. type m.c.
  levels are S3 and S4
• AP view shows disruption of foramina
• Lateral shows disruption of anterior cortex and
  possible angulation or displaced distal fragment
• Vertical fractures- result from indirect pelvic
  trauma
• AP may show asymmetry of foramina
• Not visible on lateral

http//www.imageinterpretation.co.uk/pelvis.htmls
acral
http//radiographics.highwire.org/content/21/1/83.
full
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Coccygeal Fractures

• Usually transversely oriented
• Best seen on lateral view
• May show angulation or
• anterior displacement of
• distal fragment

http//www.physioblasts.org/p/forum/forum_viewtopi
c.php?6183
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Fractures of the Ilium

• Iliac wing fxs.- AKA Duverney fx. splitting of
  iliac wing from
• direct lateral trauma
• Malgaine's fx.- double injury ipsilateral double
  vertical fracture of the superior pubic ramus and
  ischiopubic ramus, with fracture or dislocation
  of the sacroiliac joint

http//www.accessphysiotherapy.com/searchResults.a
spx?searchStriliacwingfracturesroottermiliac
wingfracturesrootID49853searchType1searchSou
rce1
http//medorder.blogfa.com/post-130.aspx
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Fractures of the Ilium

• Acetabular fractures Resulting acetabular injury
  depends on position of femur at the moment of
  impact
• -4 types
• -Posterior rim fracture (dashboard fracture)-
  occurs after a
• blow to the knee while the leg
  is flexed and adducted
• (1/3 of acetabular fxs.)
• -Simple posterior column fx- uncommon
• -Central acetabular fx. (explosion fx.)- m.c.
  acetabular fx
• divides innominate bone into
  superior and inferior halves
• -Simple anterior column fx- on AP, there is
  loss of
• continuity of the iliopubic
  line

http//www.learningradiology.com/
http//radiopaedia.org/cases/acetabular-fracture-1
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Fractures of the Ilium

• Avulsion fractures- more common in adolescents at
  apophyses before fusion of the involved growth
  centers more common in athletes
• ASIS- avulsed by sartorius muscle
• AIIS- avulsed by avulsed by rectus
• femoris muscle

http//bjsm.bmj.com/content/39/3/e16.fullglobal-t
ab-decision-support
http//radiopaedia.org/images/358415
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Pubis and Ischium Fractures

• Straddle fx.- m.c. type of unstable pelvis fx.
• Double vertical fracture that involves both
  superior pubic rami and ischiopubic junctions
  bilaterally
• Fragments may rupture the bladder

http//www.sciencedirect.com/science/article/pii/S
0022534705689185
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Pubis and Ischium Fractures

• Avulsion fractures
• Symphysis pubis- avulsion by major adductor
  muscles at superior or inferior pubic rami near
  pubic articulation
• Ischial tuberosity (riders bone)- avulsion by
  hamstring attachment
• Frequently bilateral
• Fragment may show
• overgrowth over time and
• get mistaken for osteo-
• chondroma

http//www.auntminnie.com/index.aspx?secsersubd
efpagdisItemID77031
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http//roentgenrayreader.blogspot.com/2010/07/pelv
ic-avulsion-fractures.html
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Pelvic Dislocations

• Sprung pelvis- represents complete separation of
  the symphysis pubis and one or both of the SI
  joints (pelvis looks like an open book)
• Severe pelvic basin
• visceral damage may
• occur

http//radiopaedia.org/cases/pelvic-open-book-frac
ture-1?fullscreentrue
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Pubic Diastasis

• Represents shearing separation of the pubic
  articulation
• Normal distance b/t pubic bones should not exceed
  8mm in non-pregnant adults or 10mm in children
• Often present with unilateral dislocation of SI
  joint

http//www.e-radiography.net/radpath/d/diastasis_s
ymphysis.htm
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References

• Yochum, T.R. (2005) Yochum and Rowes Essentials
  of Skeletal Radiology, Third Edition. Lippincott,
  Williams and Wilkins Baltimore.