Pr C Cyteval Montpellier University

Montpellier

PELVIS TRAUMA and

ACETABULAR TRAUMA

•  pelvic ring •  3 points of weakness

Iliopubic Complex

ilio-ischiatic complex

Acetabulum

RX Rays CT scan+++:

- Stable / unstable lesions - Seek for less visible lesions - Complications

•  stable lesions

Fractures of the iliac wing

Fractures of the anterior arch

Osseous pullout

•  teenagers

•  unstable lesions

Medial Rotation

•  Vertical shear: vertical compression hemipelvis ascent

•  Horizontal displacement Lateral rotation "Open book“

Unstable lesions

Vertical shearing

posterieur arch Fractures Isolated 5% Seek for the anterior arch fracture

3 complications •  Neurological Complications

•  Vascular complication

•  Urologic complications

ACETABULUM

1 2

1- Post ilioischiatic column

2- Anterior iliopubic column 3

3- noman’s land

CLASSIFICATION ( Letournel et Judet )

•  Simples Fractures

25 %

10 % 15 %

6 % 2 %

POSTERIOR WALL FRACTURE

Secondary to posterior femoral dislocation spontaneously reduced •  Displacement •  Incarcerated fragment •  articular Congruence •  Osteochondral impaction

Dislocation of the femoral head- Mechanism •  Posterior dislocation (85%) Flexion-adduction medial rotation •  Central dislocation (fract.transv. and columns)

•  Anterior dislocation (10%) Abduction-side rotation ext.

Dislocation of the femoral head •  Superior and posterior displacement •  of the head Volume •  Internal rotation of the femur

•  Sciatic nerve lesion •  Osteonecrosis: time reduction / trauma. +++

(5% < 6 h , 59% > 6 h ) 40% of thr post . dislocations

•  Osteoarthrosis: oteochondral impaction femoral head fracture

+ more often in ant. Dislocations

Dislocation of the femoral head: Complications

COLUMN FRACTURE

•  Anterior column:

Often assiociated with a post.column F

or transversal F

•  Posterior column :

Risk of injury to the sciatic nerve!

TRANSVERS FRACTURES

Upper portion attached to the sacrum stable

Inferior ischiopubic portion unstable

Cleavage plane in the middle of the head dislocation risk

(2nd point of rupture)

CLASSIFICATION ( Letournel et Judet ) •  Complex Fractures

9 %

5 % 3 %

19 % 3 %

2D reformation

6 vues

Other lesions of the pelvic

Help for the surgeon For displacement

Incarcetated Fragment

Total decoaptation of the femoral head during surgery needed (not systematic)

Especially in case of post dislocation

Joint Congruence

•  The femoral head has to remaine in the middle of the acetabulum in to plans

In oblic coronal and axial plan

Congruent

Not Congruent

Osteo-chondral Impaction

Femoral head Acetabulum Usually compromises good congruence

Associated Fractures

Acetabulum, sacrum and pubic disjunction

Management No impaction Good congruence

Orthopedic treatment

Impaction Bad congruence

Young patient Old patient

Surgery Prosthesis

ACETABULAR TRAUMA X Rays? CT scan+++ : •  analysis:

–  Displacement –  Incarcerated fragments –  Congruence –  Osteochondral impaction

•  Associated hidden lesions

•  Complications : Vascular, neurological, bladder