骨盆及髋臼骨折教学提纲.ppt

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1、骨盆及髋臼骨折Pelvicpathology:Undisplaced/minmallydisplaced/displaced:StablefracturePartiallystablefracture(rotational)Completelyunstable(rotationalandvertically/translationally)IsolatediliacwingfracturesUndisplacedpubicramiifracturesTransversefracturesofsacrumbelowpelvicringOscoccygisfractur

2、esAllpelvicligamentsintact!Unstablepelvicfractures:Partiallystable:Rotationallyunstable:External/internalrotation(lateralcompression)Flexion/extensionAbduction/adductionCompletelyunstable:Rotationallyandvertically(translationally)unstablePartiallystablepelvicfractures:Rotationallyunsta

3、ble:Openbookfractures>externalrotationLateralcompressionfractures>internalrotationExternalrotation:Mechanismsofinjury:PosteriorcrushDirectpressureASISExternalrotationthroughfemur(s)>Rupturesymphysis/sacrospinouslig./anteriorsacroiliacligAlwaysposteriorandinterossessacroiliacligamentsin

4、tact!Externalrotationallyunstablefracture:Partiallystablepelvicfractures:Disruptionofsymphysisonly:>Slightexternalrotation>Wideningofsymphysismax.2.5cm=OpenbookinjuryExternalrotationallyunstablefractures:Partiallystablepelvicfracture:Disruptionofsymphysis,sacrospinousligamentandanterio

5、rsacroiliacligament:>OpenbookinjuryMassiveexternalrotation>PSISabutssacrum:ExternalrotationalinstabilityExternalrotationallyunstablefractures:Partiallystablepelvicfracture:Disruptionofsymphysis,sacrospinousligament,allsacroiliacligaments:>Openbookinjurywith:MassiveexternalrotationFlexi

6、on>Transitiontovertical/translationalinstabilityInternalrotation:Mechanismsofinjury:DirectpressuretoiliaccrestForceagainstgreatertrochanter>femoralhead>acetabulumForceparalleltosacralplanethroughSI.joint(s)Internalrotationallyunstablefractures:Partiallystablepelvicfracture:Crushoflater

7、alsacrumDisruptionofposteriorsacroiliacligamentAlwaysanteriorlesion:TranssymphysealTranspubic>LateralcompressioninjuryAlwayspelvicfloorintact!Verticalshear:Mechanismsofinjury:Forceperpendicularto:SacralplaneSI-jointplane(s)Rotationallyandvertically(translationally)unstablefractures:C