Pelvis and Hip Trauma

Question 1

pelvic fractures can be classified as what

give explanation

Answer 1

stable or unstable

stable - single break - MC 2/3 of fractures
unstable - break in 2 or more places

Question 2

xray trauma evaluation of pelvis requires which lines to be intact

Answer 2

iliopectineal (iliopubic) 
ilioischial 
teardrop 
symphysis pubis 
sacrum 
acetabulum 
shentons line
arcuate lines of sacrum

Question 3

anatomic pelvis is composed of 2 arches.. what are they

Answer 3

anterior and posterior

anterior - smaller arch, pubic and ischium along with pubic ligaments and pubic symphysis

posterior - larger arch, iliac wings and sarcum suspended by sacroiliac ligaments in the body

Question 4

pelvic fracture evaluation requires to establish continuity using what 3 pelvic bony ring lines

Answer 4

pelvic inlet
pelvic outlet
obturator foramen

Question 5

stability of pelvic fractures depends on where the fracture or dislocation disrupts what structures

Answer 5

pubic symphysis

sacroiliac joints

Question 6

Most pelvic fractures result from what

Answer 6

MVA 50%
MV and person collision 30%
fall from height 10%
motorbike 4%

Question 7

what types of pelvic fractures are common in elderly

Answer 7

insufficiency pelvic fractures

Question 8

what is a stable pelvic fracture

what is a unstable pelvic fracture

Answer 8

stable - single break (MC)

unstable - break in 2 or more places

Question 9

give an example of stable pelvic fractrue

Answer 9

avulsion fractures, iliac wing fracture, sacrum fracture, ischiopubic fracture

Question 10

what hip fractures are most common among active adolescents and young adults

Answer 10

apophyseal fractures

Question 11

pelvic and hip avulsion fractures usually occur in the age range of __ to __

what is mechanism of injury

Answer 11

14-25

kicking and gymnastics
sudden detachment of tendon

Question 12

avulsion fracture of the hip may be mistaken for what

Answer 12

osteosarcoma

Question 13

what is a stable* iliac wing* fracture resulting from direct blow that is usually treated conservatively unless it is comminuted

Answer 13

duverney fracture

Question 14

what is an unstable* fracture of the hip that involves vertical shearing force* that causes an ipsilateral hemipelvic fracture* through ipsilateral rami and SI joint and ala

Answer 14

Malgaigne fracture

Question 15

patient presents with short limb on one side of fracture, what is the fracture

Answer 15

malgaigne fracture

Question 16

what unstable fracture results from lateral compression force such as car accidents

Answer 16

bucket handle fracture

Question 17

what are vertically oriented fractures through the superior and inferior pubic rami on one side as well as contralateral SI joint disruption

Answer 17

bucket handle fracture

Question 18

what unstable fractures the superior pubic ramus and ischiopubic junction bilaterally that causes bladder and urethral injury

Answer 18

straddle pelvic fracture

Question 19

what pelvic fracture is often referred to as open book fracture

Answer 19

sprung pelvis fracture dislocation

Question 20

what fracture is due to forced separation of the posterior ring through one or both SI joints with disruption of pubic symphysis and anterior ring diastasis

Answer 20

sprung pelvis fracture dislocation

Question 21

what fracture causes the iliac wings to look asymmetrical

Answer 21

sprung pelvis fracture dislocation

Question 22

proximal femur fractures tend to occur in what patients

Answer 22

elderly - especially with osteoporosis

Question 23

proximal femur fractures is the result of high or low impact trauma in elderly

Answer 23

low

Question 24

proximal femur fracture is the result of high or low impact in younger patients

Answer 24

high

Question 25

why is femoral neck fractures dangerous

Answer 25

disrupts blood supply resulting in ischemic osteonecrosis/AVN of femoral head

Question 26

intracapsular vs extracapsular prognosis

Answer 26

intracapsular worse cause affects blood supply extracapsular does not affect blood supply

Question 27

what are examples of intracapsular and extracapsular fractures of the femur head

Answer 27

intracapsular - supcapital, midcervical, basicervical | extracapsular - trochanteric and subtrochanteric

Question 28

what classification method is used to determine and predict stability of injury

Answer 28

garden classification

Question 29

many define basicervical fracture as what fracture

Answer 29

intertrochanteric

Question 30

garden classication of femoral neck fractures

Answer 30

graden 1 - incomplete garden 2 - complete but non displaced garden 3 - complete and partially displaced garden 4- complete and displaced entirely (fragments are not together)

Question 31

what femoral neck fractures are diffucult to diagnose

Answer 31

undisplaced subcapital fracture - seen as line of sclerosis either complete or incomplete caused by impaction

Question 32

patient presents with inability to walk or stand and their limb appears shortened and externally rotated

Answer 32

dispaced femoral neck fractures

Question 33

intertrochanteric femoral fractures are result of what

Answer 33

violence, falls, car and pedestrian

Question 34

what fractures of the femoral neck are more common in younger patients

Answer 34

interchocanteric and subtrochanteric fractures

Question 35

extracapsular fractures such as intertrochanteric and subtrochanteric fractures often occur with significant force that results in what type of fracture

Answer 35

comminuted

Question 36

what are complications of extracapsular fractures

Answer 36

fat pulmonary embolisms

Question 37

subtrochanteric fractures occur 2 cm inferior to the ____

Answer 37

lesser trochanter

Question 38

what population is more susceptible to hip dislocations

Answer 38

people with prosthesis his dislocated more readily and with less force

Question 39

what is the most common hip dislocation

Answer 39

posterior

Question 40

which hip dislocation is associated with acetabular fracture

Answer 40

central hip dislocation - protrusio

Question 41

what is a complication of posterior hip location

Answer 41

damage sciatic nerve | posterior hip capsule damage

Question 42

what is mechanism of posterior hip dislocation

Answer 42

MVA and dashborad injury

Question 43

posterior dislocation causes damage to sciatic nerve which presents as what

Answer 43

unable to walk with general paresthesia in limb

Question 44

in posterior hip location the femoral heads is displaced where? how is leg positioned

Answer 44

posterior, superior, and lateral internally rotated - can barely seen less trochanter on xray femoral head will also appear smaller on that side compared to other

Question 45

what modality is needed for evaulation of posterior dislocation

Answer 45

CT

Question 46

what sacral fractures are infrequet

Answer 46

isolated sacral fracture

Question 47

isolated sacral fractures are often __ oriented and due to direct blow

Answer 47

transverse

Question 48

when sacral fractures are part of complex injury they are usually ___ oriented and fracture through sacral foramen

Answer 48

vertical

Question 49

sacral fractures that develop due to insufficiency and stress fractures that are ___ to SI joints

Answer 49

parallel

Question 50

what do you look at on the sacrum to look for fractures

Answer 50

arcuate lines and sacral foramina

Question 51

what classification is used to classify sacral fractures

Answer 51

Denis classification zone 1 zone 2 - through sacral foramina zone 3 - transverse down the middle zone 4 - transverse - looks like a U - down sacral foramen then across then up sacral foramen

Question 52

what other fractures in the vertebral column would indicate suspicion of sacral fracture

Answer 52

fracture of L4-L5 TP

Question 53

what is another way besides CT and xray to view sacral fractures? what specific fracture

Answer 53

radionuclide bone scans - HONDA sign insufficiency fracture

Question 54

coccyx fractures result from what

Answer 54

falls on buttock and direct impact