Pelvis

Question 1

What are 3 major arterial vessels injured in pelvic fractures

Answer 1

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

Question 2

Signs of posterior pelvic instability?

Answer 2

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

Question 3

Classification of Pelvic #’s

Tile vs. Young-Burgess

Answer 3

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

Question 4

Describe the Tile classification

Answer 4

A: stable
B: open book
C: vertical shear

Question 5

When are pelvic binders helpful?

Answer 5

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

Question 6

When do you worry about rami fractures?

posterior displacement

Answer 6

Bilateral
Butterfly segments
Significant displacement

Question 7

2 mechanisms for unstable pelvic fractures

Answer 7

High energy

MVC’s and falls from height

Question 8

What degree of symphysis widening is considered unstable?

Answer 8

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

Question 9

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

Answer 9

S4

Question 10

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

Answer 10

Vaginal exam?
Rectal exam?
Look for external bleeding

Question 11

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

Answer 11

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

Question 12

What injury is associated with acetabular fractures (posterior column)

Answer 12

Posterior hip dislocation

Question 13

Where do patients complain of pain in acetabular fractures

Answer 13

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

Question 14

What muscle inserts onto AIIS

anterior inferior iliac spine

Answer 14

rectus femoris

Avulsion # classic mechanism is kicking a ball

Question 15

What muscle inserts onto ASIS

anterior superior iliac spine

Answer 15

sartorius

Classic mechanism is sprinting/running in adolescent

Question 16

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

Answer 16

< 2 cm
protected weight bearing
ortho F/U

Question 17

What muscle inserts on the ischial tuberosity?

Mechanism of avulsion #?

Answer 17

Hamstrings

Splits, hurdles

Question 18

What muscle inserts on lesser trochanter

What mechanism of avulsion #?

Answer 18

Iliopsoas

Sudden flexion

Question 19

What scenarios require a bedside retrograde cystourethrogram?

Answer 19

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

Question 20

How do you perform a retrograde cystourethrogram?

When should you time it with the CT scan

Answer 20

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

Question 21

What muscle attaches to the ASIS?

What is the mechanism of avulsion injury?

Answer 21

Sartorius

Running

Question 22

What muscle attaches to the AIIS?

What is the mechanism of avulsion injury?

Answer 22

Rectus femoris

Kicking (sudden contraction of quads)

Question 23

What muscle attaches to the ischial tuberosity?

What is the classic mechanism of avulsion injury?

Answer 23

Hamstrings

Hurdles

Question 24

What muscle attaches to the lesser trochanter?

What is the classic mechanism of avulsion injury?

Answer 24

Iliopsoas

Sudden hip flexion

Question 25

What is the treatment of pelvic avulsion injuries?

Answer 25

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