1
Fifth stage
Surgery-Ortho
Lec-13
.د
مثنى
1/1/2014
Pelvic fractures-2
Severe vertical shear and compression injuries are the most dangerous and most difficult to
treat. The fracture or dislocation must be stabilized by external fixation or posterior iliosacral
screw, anterior plating with posterior iliosacral screw . Vertical force fractures may be
treated by open reduction and internal fixation or skeletal traction and non weight bearing
for 3 months
Complications
Early complications
Shock: (hemorrhage) resuscitation stabilization of fractures or surgical intervention.
Visceral injuries
Diaphragmatic injuries.
Nerve injuries
Late complications
Sacroiliac pain.
Distortion of pelvic canal.
Osteoarthritis.
Fracture acetabulum
Fractures of the acetabulum occur when the head of the femur is driven into the pelvis.
This is caused either by a blow on the side (as in a fall from a height or road traffic accident )
or by a blow on the front of the knee, usually in a dashboard injury when the femur also may
be fractured.
Clinical features:
There is usually history of a severe injury; associated fractures are not uncommon and may
divert the attention from the more urgent pelvic injuries. Whenever a fractured femur, a
severe knee injury or a fractured calcaneum is diagnosed, the hips also should be x-rayed.
2
The patient may be severely shocked. There may be bruising around the hip and the limb
may lie in internal rotation (if the hip is dislocated).
Neurological examination is important, testing the function of the sciatic, femoral and
obturator . Several X-ray views of the hip are needed to visualize the fracture accurately. CT
scans are particularly helpful if surgical reconstruction is planned.
Treatment of acetabulum fractures:
The first priority is to counteracthe shock and reduce a dislocation. Skeletal traction is then
applied to the distal femur (10 Kg). During the next 3–4 days the patient’s general condition
is brought under control. Definitive treatment of the fracture is delayed until the patient is
fit and operation facilities are optimal.
Definitive treatment:
undisplaced fractures and fractures that do not involve the roof ( weight bearing portion),
skeletal traction is applied for 6-8 weeks , followed by non weight bearing for other 6 weeks.
Operative treatment are indicated for all displaced fractures to get perfect anatomical
reduction.
Complication:
shock, deep venous thrombosis, visceral injuries, sciatic nerve injury, heterotropic bone
formation, avascular necrosis of the head of the femur, hip stiffness and secondary
osteoarthritis.