Isolated iliac wing fractures, avulsion fractures of the iliac spines or ischial tuberosity, nondisplaced pelvic ring fractures. Complications may include internal bleeding, injury to the bladder, or vaginal trauma common causes include falls, motor vehicle collisions, a vehicle hitting a pedestrian, or a direct crush. Multiple fx of pelvis w stable disrupt of pelvic ring, init. Young and burgess classification pelvic fractures ap compression apc direct anterior force type 1. Openbook pelvic fracture with soft tissue serious damage in a child. A sentence in the body of the report indicates this is an open book pelvic fracture. The definitive treatment of open book fractures is usually achieved by open reduction, internal fixation or external fixation. Independent experimental variables of the pelvic strap. Anterior pelvic injuries wheeless textbook of orthopaedics. Pdf open reduction and internal fixation of a traumatic. However, the mortality still remains significantly high. Bladder incarceration following anterior external fixation. Open reduction and internal fixation orif is usually indicated when diastasis of the pubic symphysis exceeds 2. Open book pelvic injuries are most often the result of highenergy trauma and are.
Pelvic fracture in emergency medicine differential diagnoses. External rotation of the hemipelvis requires binding and likely surgical fixation. In 60%, a laceration of the iliolumbar vein occurred after 5 cm of pubic diastasis. Noninvasive reduction of openbook pelvic fractures by. However, haemorrhage is usually the leading cause of death. Some have argued that in the stable open book pelvic disruption where the posterior pelvic integrity is maintained, only 1 plate full text plating a pubic diastasis following a pelvic ring.
Open book fractures, lateral compression fractures, and buckethandle fractures. This includes any break of the sacrum, hip bones ischium, pubis, ilium, or tailbone. Patients who survive an open pelvic fracture are often left with longstanding or permanent disabilities which can be challenging to any healthcare system. Openbook pelvic fractures associate a diastasis andor a fracture of the pubic rami with a posterior pelvic disruption of the sacroiliac joint. It usually corresponds to tile b injury, in which the posterior ligamentous structures remain intact resulting in rotational instability of the pelvis. Treatment is conservative if spontaneous reduction of type b2 pubic symphysis diastasis 2. Surgery if symphasis pubic diastasis is more than 2. A sheet can be tied around the pelvis, or the legs can be tied together in an internally rotated position to approximate an anterior pelvic diastasis. Classification of pelvic fractures litfl ccc trauma. Open book pelvic injury radiology reference article radiopaedia. Consecutive open book fracture model, subsequently simulating two distinct injury severity patterns, corresponding to ota classifications 61b1 and 61c1. This is often the result from a heavy impact to the groin pubis, a common motorcycling accident injury. The case discussed is an open book fracture type b1, tile classification associated with triradiate cartilage injury type i, salterharris classification in an 11yearold.
They observed that each millimeter of pubic diastasis or inferomedial pubic bone fracture fragment displacement was associated with a 10% increased risk of urethral injury. While some open book injuries with slight symphyseal diastasis do not need surgery, there is no specific width that separates stable from unstable injuries. A prototype pelvic strap was applied subsequently at three distinct transverse levels around the pelvis. Joint replacement procedures will be discussed in the second section. These methods rely on immobilization and partial reduction of displacement. Open reduction and internal fixation of a traumatic diastasis of the pubic symphysis. A pelvic fracture is a break of the bony structure of the pelvis. Diastasis widening of the pubic symphysis greater than 1 cm can represent instability with diastasis greater than 2. Closeup view of the pelvis shows widening of both sacroiliac joints white arrows, right greater than left, and marked widening of the symphysis pubis red arrow. Pelvic fractures pediatric orthopaedic society of north. In this kind of injury, the left and right halves of the pelvis are separated at front and rear, the front opening more than the rear, i. Operative treatment for incomplete disruption posterior.
Open book pelvic injury radiology reference article. Both rami fractured on both sides or both rami on one side with pubic. Adolescents with a closed triradiate cartilage most commonly sustain fractures of the acetabulum, diastasis of the pubic symphysis, and separation of the sacroiliac joints. Circumferential pelvic compression was induced by gradual tensioning of the strap to attempt complete reduction of the symphysis diastasis.
The pelvis and hips introduction this chapter will address clinical and imaging aspects of orthopaedic procedures in the pelvis and hips. Reduce anterior symphyseal diastasis diastasis of symphysis pubis and both sacroiliac joints sprung pelvis. Type b fracture is further divided into three subtypes i. Pelvic fractures in children very rare in children 0. Diastasis of the symphysis pubis rarely coexists with fractures of the pubic rami 3,4. Internal fixation is performed to relieve pain and improve stability of the anterior pelvic. Operative treatment absolute indication relative indication open pelvic fractures open book fracture or unstable fracture associated with hemodynamic instability symphysis diastasis 2.
One specific kind of pelvic fracture is known as an open book fracture. Principle of treatment theoretically, due to the intact posterior hinge, open book injuries can be stabilized by reducing and fixing the anterior arch disruption. Pelvic vertical shear fracture open book fracture pubic symphysis diastasis open book pelvic fracture radiographic views for acetabular fractures acetabular fracture of posterior column posterior acetabular and femoral head fractures anterior acetabular wall fracture anterior acetabular column fracture. Openbook fractures of the pelvis are uncommon during childhood and require urgent treatment from the association with other abdominal, vascular or nervous injuries. An immature pelvis with open triradiate cartilage most commonly sustains fractures of the pubic rami and iliac wings. Displaced pelvic fractures can be stabilized temporarily by simple means during the initial evaluation and transportation. The mortality rate is 1525% for closed pelvic fractures and as much as 50% for open pelvic fractures. Anatomical consequences of openbook pelvic ring disruption. The authors concluded that open book fractures create an increase of pelvic volume that facilitates blood diffusion from the pelvic vessels. Open book fracture with symphyseal diastasis diastasis 2 cm demands anterior external fixation with possible fixation for the posterior injury.
Open book fractures of the pelvis are uncommon during childhood and require urgent treatment from the association with other abdominal, vascular or nervous injuries. Open pelvic fractures account for 24% of all pelvic fracture and are lifethreatening injuries that provide a challenge to any trauma team. Application of multiplanar external fixator to pelvis and then external fixation of pelvic ring fracture, specifically external fixation of the sacral fracture, left acetabular fracture, pubic symphysis diastasis and pubic ramus fracture. In type b1, open book symphysial diastasis is less than 2.
Open book pelvic injuries are most often the result of highenergy trauma and are associated with significant morbidity and mortality due to associated vascular injuries pathology. Pelvic fractures are a special consideration for dpl because there. Demonstration of the correct placement of a pelvic binder for an open book pelvic fracture with diastasis of the pubic symphysis. Open book pelvic injuries result from an anteroposterior compression injury to the pelvis and result in a combination of ligamentous rupture andor fractures to both the anterior and posterior arches 5. Openbook fractures of the pelvis are uncommon during childhood and require. When managing open pelvic injuries, it is essential to first resuscitate the patient and assess their airway, breathing, circulation and disability, in accordance with the advanced trauma life support guidelines.
Pelvic fracture overview everything you need to know. The bony pelvis provides protection to the lower abdominal and genitourinary tract as well as the great vessels of the pelvic floor and. The case discussed is an openbook fracture type b1, tile classification associated with triradiate cartilage injury type i, salterharris classification in an 11yearold. Karam introduction diastasis of the pubic symphysis is often part of a complex injury to the pelvic ring. Open book pelvic injuries entail diastasis of the symphysis pubis, resulting in external rotational deformity of the involved hemipelvis. Vertical shear displacement of the hemipelvis superiorly or posteriorly involving diastasis of the pubic symphysis, rami fractures, displacement of the sacroiliac joint, andor fractures of the iliac wing or sacrum. In type b2, open book symphyseal diastasis is greater than 2. Pdf openbook pelvic fracture with soft tissue serious. He was hemodynamically stable on admission, and multiple injuries were identified including an unstable open book pelvic ring disruption right, nondisplaced superior and inferior ramus fractures, a symphyseal diastasis of 4 cm and complete disruption of the right sacroiliac joint.