V01-Anatomy, Class Pelvis.ppt

Radiographic Evaluation, Anatomy, and Classification of Pelvic Ring Injuries Kyle F. Dickson, MD Chief of Orthopaedics, Charity Hospital Director of Orthopaedic Trauma Tulane UniversityCreated March 2004 Palpable Bony Landmarks Symphysis Pubis Anterior Superior Iliac Spine (ASIS) Iliac Wing Posterior Superior Iliac Spine (PSIS) Pelvic Ring 2 innominate bones 1 Sacrum Gap in symphysis 5 mm SI joint 2-4 mm Important Stabilizing Ligaments Posterior Iliosacral Anterior Iliosacral Sacrospinous Sacrotuberous Symphyseal Important Muscles Gluteus Maximus Iliopsoas Rectus Abdominus Possible Arterial Bleeders in Pelvic Injuries Iliolumbar artery Superior gluteal artery Lateral sacral artery Internal iliac artery Internal pudendal (active bleeding most commonly found) Neurologic Damage L5 S1, most common L2 to S4 possible Dependent on location of fracture and amount of displacement Denis, CORR 1988 Sacral Fractures – Neurologic Injury Lateral to foramen – 6% injury Through foramen – 28% injury Medial to foramen – 57% injury Pohlemann, CORR 1994 Amount of displacement move important then location Potentially Damaged Visceral Anatomy Blunt vs. impaled by bony spike Bladder/urethra Rectum Vagina Pelvic Ring No inherent stability Ligaments give the pelvis stability Symphyseal Ligaments Resist external rotation in double-leg stance Rami act as struts to resist compressive and internal rotation in single leg stance Sectioning causes little pelvic instability Ghanayem, J Trauma 1995 Abdominal wall contributes to pelvic stability (laparotomy increased pelvic displacement in cadaveric model) SI Joint Transfers Load from Appendicular to Axial Skeleton Sacrum Inlet View Reverse keystone where compression forces displace sacrum anteriorly Outlet View True keystone compression locks sacrum into pelvic ring Small rotating movements during gait Posterior Ligaments Ant. SI Joint – resist external rotation Post. SI and Interosseous – posterior stability by tension band (strongest in