Pelvic Fractures
Pelvic fractures range from benign avulsion fractures in athletes to life-threatening "Open Book" injuries in trauma patients. The pelvis is a ring structure; like a pretzel, it is difficult to break a ring in just one place.
1. Young-Burgess Classification
Based on the mechanism of injury:
- Anteroposterior Compression (APC): "Open Book" injury. Symphysis pubis widens. Potentially severe hemorrhage.
- Lateral Compression (LC): Most common. Force from the side crushes the sacrum and pubic rami. Usually stable.
- Vertical Shear (VS): Fall from height. One hemipelvis shifts vertically. Highly Unstable.
2. Stability (Tile's Classification)
- Type A (Stable): Posterior arch is intact. (e.g., Avulsion fractures, isolated pubic ramus fracture).
- Type B (Rotationally Unstable, Vertically Stable): "Open Book" type. The floor is open, but the posterior ligaments hold vertically.
- Type C (Unstable): Complete disruption of posterior sacroiliac complex. The pelvis is loose in all planes.
3. Clinical Features
- Destot's Sign: Hematoma above the inguinal ligament or in the scrotum/labia.
- Hemodynamic Instability: Pelvic volume increases, allowing massive blood loss (up to 4 liters).
4. Management
- Emergency: Pelvic Binder (sheet wrap) to close the volume and tamponade bleeding.
- Stable (Type A): Bed rest for 2-3 weeks, then mobilization.
- Unstable (Type B/C): External Fixator (anterior) or internal fixation (plates/screws).
25 Practice MCQs
Q1. Which pelvic fracture is considered an "Open Book" injury?
Answer: A). The symphysis pubis opens up like a book.
Q2. What is the most common source of massive bleeding in pelvic fractures?
Answer: B). 85% of bleeding is venous from the bone edges and plexus.
Q3. Malgaigne fracture involves:
Answer: A). Highly unstable vertical shear injury.
Q4. Sprinter's Fracture is an avulsion of:
Answer: A). Pulled by the Sartorius muscle.
Q5. Avulsion of the Ischial Tuberosity is caused by which muscle?
Answer: A). Common in hurdles/cheerleaders.
Q6. Destot's Sign indicates:
Answer: A). Signifies pelvic floor disruption.
Q7. Which organ is most commonly injured in anterior pelvic fractures?
Answer: A). Posterior urethra in males especially.
Q8. Tile's Type A fractures are:
Answer: A). Posterior arch is intact.
Q9. The immediate management for a hemodynamically unstable "Open Book" fracture is:
Answer: A). Reduces pelvic volume to stop venous bleeding.
Q10. Vertical Shear (VS) injuries are characterized by:
Answer: A). Complete disruption of all ligaments.
Q11. Straddle Fracture involves:
Answer: A). "Butterfly" fragment is floating.
Q12. Duverney's Fracture is:
Answer: A). Usually stable (Type A).
Q13. Rectus Femoris avulses from:
Answer: B). Straight head of Rectus Femoris.
Q14. Morel-Lavallée lesion is:
Answer: A). Fat separates from fascia, filling with fluid. High infection risk.
Q15. Weight bearing in stable pelvic fractures (Type A) is usually:
Answer: A). Early mobilization prevents complications.
Q16. "Windswept Pelvis" occurs in:
Answer: A). Like wind blowing the legs to one side.
Q17. The posterior sacroiliac ligaments are:
Answer: A). If these rupture (Type C), surgery is needed.
Q18. What X-ray view best shows the SI joints and sacrum?
Answer: A). Outlet shows vertical migration; Inlet shows AP displacement.
Q19. Mortality in pelvic fractures is mostly due to:
Answer: A). The "Golden Hour" is critical.
Q20. External Fixation pins are usually placed in the:
Answer: A). "Handlebars" for the pelvis.
Q21. Coccydynia is pain in the:
Answer: A). Treated with a donut cushion.
Q22. Open pelvic fractures have a mortality rate of:
Answer: A). Due to contamination (rectum/vagina) and massive bleeding.
Q23. Angiography and Embolization are used for:
Answer: A). If the patient remains unstable despite binder/fluids.
Q24. Heterotopic Ossification is a complication of:
Answer: A). Bone forms in the muscles.
Q25. The pelvis is most stable in:
Answer: B). However, weight bearing is restricted until healing begins.
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