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Pelvic Fracture

Pelvic Fracture. Anatomy. 2 innominate 1sacrum Innominate bone ilium,ischium,pubis Join by strong ligament complex. Minor injury. Minor fall Stable vital sign Non-displaced Fx Fx not involve ring Treatment-bed rest. Minor injury. Major injury. High energy trauma

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Pelvic Fracture

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  1. Pelvic Fracture Anatomy • 2 innominate 1sacrum • Innominate bone ilium,ischium,pubis • Join by strong ligament complex

  2. Minor injury • Minor fall • Stable vital sign • Non-displaced Fx • Fx not involve ring • Treatment-bed rest

  3. Minor injury

  4. Major injury • High energy trauma • Unstable vital sign • High mortality,morbidity • Associated injury

  5. Associated injury Rupture bladder Rupture urethra L-S plexus injury

  6. Associated injury Hypovolemic shock Retroperitonium hematoma bleeding bony surface venous plexus bleeding vascular injury

  7. SI joint widening Symphysis seperation Mechanism of injury AP compression (open book)

  8. Fx ilium Lock symphysis Mechanism of injury Lateral compression(internal rotation)

  9. SI dislocate Symphysis dislocate Mechanism of injury Vertical shear (Malgaigne Fx)

  10. Major injury initial management • Recuscitation • Pelvic stabilization external fixator • Definite treatment pelvic sling ORIF

  11. Fracture of proximal femur Surgical anatomy Vascular anatomy

  12. Fracture neck of the femur • Intracapsular Fx • High rate of nonunion, avascular necrosis • 2 aged groups 1.Young adult high energy 2.Older with osteoporosis minor fall

  13. Fracture neck of the femur

  14. Fracture neck of the femur • PE: • Limb slightly shortening • Pain at groin • Tenderness at midinguinal point Older patient ,minor injury Please X ray both hip AP ,lat crosstable

  15. Treatment Young adult ,good bone quality Reduction and multiple pinning

  16. Treatment Older with osteoporosis Hemiarthroplasty

  17. Complication • Nonunion • Avascular necrosis • Venous thrombosis

  18. Intertrochanteric Fracture • Fx line from greater to lesser trochanter • More common in woman menopause • Extracapsular fracture • Older with osteoporosis -minor fall

  19. PE: • Limb shortening,external rotation • Swelling ,ecchymosis at hip • Tenderness at greater trochanter

  20. Treatment Non operative traction 6 wks. high complications Pressure sore venous thrombosis infection

  21. Operative treatment is preferable surgical risk, early ambulation

  22. Subtrochanteric Fracture • Fx at level of lesser trochanter and a point 5 cm. Distally • thick cortical bone • high mechanic stress • high energy trauma

  23. Treatment Operative treatment is preferable

  24. Hip Dislocation • Posterior dislocation 80% most common • Anterior dislocation 5% • Central dislocation 15%

  25. Posterior dislocation Blow to femur in adduction internal rotation of the hip Dashboard injury

  26. Posterior dislocation PE: • hip flexion,internal rotate and adduct • ass.knee ligament injuries • assess sciatic nerve

  27. X-ray • Head out of acetabulum • smaller femoral head • femur adduct, internal rotate(disappear lesser trochanter)

  28. Treatment • Early diagnosis • prompt closed reduction • Allis’s maneuver • failed closed reduction-open reduction

  29. Posterior dislocation Allis’s maneuver • Stabilized pelvis • longitudinal traction • 90 degree hip flexion • upward traction

  30. Posterior dislocation Allis’s maneuver

  31. Management after reduction • Test for stability • X-ray both hip AP evaluate joint space • Stable reduction skin traction- pain subside ambulation with crutches • Unstable reduction ORIF

  32. Posterior dislocation Joint space widening Fragment entrap in joint

  33. Anterior dislocation Blow to femur in abduction,external rotate of hip joint

  34. Treatment • Early diagnosis • prompt closed reduction • Allis’s maneuver • failed closed reduction-open reduction

  35. Anterior dislocation Reduction technique • General anesthesia • Traction along axis • Internal rotation • Lateral traction

  36. Anterior dislocation Clinical manifestation X ray

  37. Anterior dislocation Stabilized pelvis Internal rotation Traction along axis Lateral traction

  38. Anterior dislocation Post reduction • X ray pelvis AP • Skin traction until pain subside(5-7 d) • Ambulation with crutches

  39. Fracture shaft of the femur • High energy injury • Bleeding 1- 2.5 L. • Ass. femoral neck Fx. • Ass. hip dislocation

  40. Physical examination • Deformity of thigh angulation shortening • PE.of hip and knee • Vascular assessmentdorsalis pedis a.posterior tibial a.

  41. Management • Splinting - Thomas’s splint • Film femur include hip-knee detect neck Fx-dislocate hip • Temporary stabilization with proximal tibial traction

  42. Management • Non-operative treatment Traction 6-8 wks. Femoral castbrace 10-12wks. • Operative treatment ORIF with plate-screw Intramedullary nailing

  43. Transverse Fx midshaft femur ORIF with plate-screw

  44. Comminuted Fx midshaft femur Intramedullary nail

  45. Supracondylar fracture • Fx distal femoral metaphysis 9 cm. above joint line • Posterior displacement of the distal fragment • High rate of stiffed knee

  46. Supracondylar Fx (extra-articular) Intercondylar Fx (intra-articular) T or Y Fx (combined) How to described Fx?

  47. Treatment • Conservative Traction stiffed knee • Operative Early function Early knee motion

  48. T Fracture of distal femur ORIF with plate and screw

  49. Fracture of the patella • Largest sesamoid • Function -lever arm for knee extension -protect condyle

  50. Avulsion(traction) Quads. pull up Knee flexion • Direct injury Mechanism of injury

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