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Flashcards in Pelvis Deck (25):
1

What are 3 major arterial vessels injured in pelvic fractures

1. Obturator
2. Gluteal
3. Pudental
But most bleeding is venous

2

Signs of posterior pelvic instability?

1. Avulsion fracture of ischial spine (connecting ligament)
2. L5 transverse process #
3. Widening of SI joint

3

Classification of Pelvic #'s
Tile vs. Young-Burgess

Stable - chip off one side of pelvis
Horizontal # through sacrum usually stable, but if above S4 higher chance of nerve involvement
Unstable - vertical up and down

4

Describe the Tile classification

A: stable
B: open book
C: vertical shear

5

When are pelvic binders helpful?

Open book fractures (Tile B)
Close space to have less room to bleed
Tile C (don't put on binders snugly, can worsen bleeding)

6

When do you worry about rami fractures?
(posterior displacement)

Bilateral
Butterfly segments
Significant displacement

7

2 mechanisms for unstable pelvic fractures

High energy
MVC's and falls from height

8

What degree of symphysis widening is considered unstable?

> 0.5 cm is abnormal
> 2.5 cm is unstable
(up to 9 mm widening in pregnancy is normal)

9

What level of sacral foramen is concerning for neurologic damage in horizontal fractures

S4

10

If suspicious of open pelvic fractures and nothing is visualized exteriorly - where should you look?

Vaginal exam?
Rectal exam?
Look for external bleeding

11

What does Rosen's quote for mortality in pelvic fractures with hypotension?
Disposition?

30-40%
Textbook: OR
In real life: IR then OR if you can

12

What injury is associated with acetabular fractures (posterior column)

Posterior hip dislocation

13

Where do patients complain of pain in acetabular fractures

Groin
Unable to weight bear
Can pound inferior aspect of heel - hurts in groin

14

What muscle inserts onto AIIS
(anterior inferior iliac spine)

rectus femoris
Avulsion # classic mechanism is kicking a ball

15

What muscle inserts onto ASIS
(anterior superior iliac spine)

sartorius
Classic mechanism is sprinting/running in adolescent

16

What amount of displacement is acceptable for conservative management of AIIS or ASIS avulsion fractures

< 2 cm
protected weight bearing
ortho F/U

17

What muscle inserts on the ischial tuberosity?
Mechanism of avulsion #?

Hamstrings
Splits, hurdles

18

What muscle inserts on lesser trochanter
What mechanism of avulsion #?

Iliopsoas
Sudden flexion

19

What scenarios require a bedside retrograde cystourethrogram?

Blood at meatus
High riding prostate
Genital ecchymosis
Urinary retention
Gross hematuria

20

How do you perform a retrograde cystourethrogram?
When should you time it with the CT scan

Need: 60 cc syringe, contrast dye (high density), christmas tree adapter
Inject into urethra slowly over 1 min
After 30 seconds, 1 min - Xray
Look for extravasation

Do after scan - otherwise the dye can interfere with the bone imaging

21

What muscle attaches to the ASIS?
What is the mechanism of avulsion injury?

Sartorius
Running

22

What muscle attaches to the AIIS?
What is the mechanism of avulsion injury?

Rectus femoris
Kicking (sudden contraction of quads)

23

What muscle attaches to the ischial tuberosity?
What is the classic mechanism of avulsion injury?

Hamstrings
Hurdles

24

What muscle attaches to the lesser trochanter?
What is the classic mechanism of avulsion injury?

Iliopsoas
Sudden hip flexion

25

What is the treatment of pelvic avulsion injuries?

Non weight bearing, ortho f/u
Then weight bearing as tolerated
Operative intervention may be required if >2 cm displacement