short presentation on the pelvis Injuries and Management in general , about bladder Injury, urethral injuries

1. Injuries of the pelvis
Prepared by ; Dr.Seerwan M J

2. Injuries of the pelvis
1. Introduction & Surgical
Anatomy
2. Instability
3. Clinical Assessment
4. Stable and unstable injuries
5. Management

3. Introduction & Surgical Anatomy
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5% of all skeletal injuries
Important !
2/3 occur in RTA pedestrian
10% associated visceral Inj.
10 % Mortality

4. Introduction & Surgical Anatomy
• Stability depends on the Ligaments & bone

5. Introduction & Surgical Anatomy
• Common iliac artery, lumber & sacral plexus
bladder , urethra.

6. Instability & trauma
Anterior
force
Vertical
shear
Lateral
foces

7. Clinical Assessment
• Fracture pelvis Should be suspected in :
– Abdominal or LL injuries
– RTA, FFH
Patient have severe pain, swelling, bruising of
lower abdomen
Inspection (lower abd., thigh, perineum,
scrotum , vulva)
Priority is to the patients’ general condition
and blood loss , resuscitation before
examination.

8. Clinical Assessment
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Abdomenal examination
Pelvic ring
Rectal examination
Urine color
(no catheter should be inserted)
Bladder injuries
Neurological

9. Clinical Assessment- radiology

10. Clinical Assessment

11. best demonstrates ring configuration of
pelvis, & narrowing or widening of diameter of
ring is immediately apparent.
- evaluates for posterior displacement of
pelvic ring or opening of pubic symphysis

12. ,shows the anterior ring superimposed on the posterior ring.
- evaluates for vertical shift of pelvis (migration of hemipelvis);
- proximal or distal displacements of anterior or posterior
portion of ring are best appreciated on this view;
- sacrum appears in its longest dimension, w/ neural foramina
evident.

13. shows iliopectineal line anterior column of
pelvis & posterior wall;
-

14. shows ilioischial line (posterior) column & anterior wall;

15. Stable & unstable Injuries
Stable injuries
Unstable injuries
1.ANTEROPOSTERIOR
COMPRESSION (APC)
INJURIES; APC I, APCII
1.APCIII
2.LATERAL
COMPRESSION (LC)
INJURIE; LCI,LCII
2.LCIII
3.VERTICAL SHEAR
(VS) INJURIES
Full weight bearing
without the risk of
pelvic deformity

16. 1.Early
management
4.Treatment
of fracture
Mx
3.Mx of the
urethra and
bladder
2.Mx of
sever
bleeding