Pelvic Fracture

Excerpt

The pelvis is naturally designed to be a highly stable structure. Pelvic ring fractures occur most commonly in the setting of a high-impact trauma and are often associated with additional fractures or injuries elsewhere in the body. Certain pelvic fractures do not disrupt the pelvic ring, eg, iliac wing fractures, and can typically be managed without operative intervention. Similarly, acetabulum fractures frequently occur, particularly in high-energy traumas, hip dislocations, and falls in older adults. These injuries are studied in detail and classified by the fracture's anatomy.

The Young-Burgess classification is a valuable evaluation tool when diagnosing pelvic ring injuries. By correctly assessing a pelvic ring injury, trauma surgeons and emergency physicians can provide adequate initial treatment and convey important information about the injured structures' anatomy to the orthopedic surgeon managing the condition.

To appropriately apply the Young-Burgess classification system of pelvic ring injuries, clinicians must understand pelvic ligamentous anatomy. The bony pelvis is comprised of the ilium, ischium, and pubis. These structures form an anatomic ring with the sacrum. The symphyseal ligaments stabilize the pubic symphysis on the anterior side. The pelvic floor ligaments and posterior sacroiliac complex stabilize the pelvic ring on the posterior aspect. The sacrospinous and sacrotuberous ligaments of the pelvic floor, anterior to the sacroiliac joint, resist both shear and external rotation through the sacroiliac joint. The posterior sacroiliac complex is the most posterior ligament in the pelvic ring and the most essential structure for pelvic ring stability. Injury to the posterior ligaments reveals a very high-energy injury mechanism.

Pelvic ring injuries are usually accompanied by severe soft tissue disruption. Thus, vascular, neurologic, and visceral injuries are common and must be ruled out. The posterior pelvis' venous plexus accounts for most hemorrhage associated with pelvic ring injuries. The corona mortis is an anastomosis between the external iliac and obturator artery, a branch of the internal iliac artery. Intraoperative corona mortis damage can quickly result in a bad outcome due to excessive blood loss within the pelvis.