For 3rd Yrs BPT

1. Pelvis Fracture
DR. SUNNY ANAND
Assistant Professor
Krupanidhi College Of Physiotherapy
4th Sept 2021

2. Introduction
The pelvis is a basin-shaped structure that supports the spinal
column and protects the abdominal organs. It contains the following
ilium, ischium, and pubis.
Why is it called pelvis?
Pelvis itself comes from the Latin for a basin shape. The acetabulum, the
hollowing in the bony pelvis that forms the receptive portion of the hip
articulation, is named after the small cup used to hold a popular
dipping sauce at Roman dining tables

4. Function Of Pelvis
(1) locomotion, as body weight is transmitted to the lower
limbs through the pelvic girdle,
(2) childbirth, as the human neonate must pass through the
birth canal, which lies within the pelvic girdle as the baby
exits the body, and
(3) support of abdominal organs

5. Types Of Pelvis

6. TILE CLASSIFICATION
● Tile A
— Rotationally and vertically stable
— pubic ramus fracture, iliac wing fracture, pubic stasis diastasis <2.5 cm
● Tile B
— Rotationally unstable, vertically stable
B1: pubic symphysis diastasis >2.5 cm and widening of the sacroiliac joints
(open book fracture due to external rotation forces on the hemipelvises)
B2: pubic symphysis overriding Unilateral
B3:pubic symphysis overriding Bilateral
● Tile C
— Rotationally and vertically unstable
— disruption of SI joints due to vertical shear forces
C1: unilateral
C2: bilateral
C3: involves acetabulum

8. Classification Of Pelvis Fracture

9. The Young and Burgess classification is a modification of the earlier Tile classification 1. It is the
recommended 5 and most widely used classification system for pelvic ring fractures.
It takes into account force type, severity, and direction, as well as injury instability.
Three basic mechanistic descriptions are used, each with degrees of severity.
Classification
Anteroposterior compression (APC)
● APC I: stable
pubic diastasis <2.5 cm
● APC II: rotationally unstable, vertically stable
pubic diastasis >2.5 cm
disruption and diastasis of the anterior part of the sacroiliac joint, with intact posterior
sacroiliac joint ligaments
● APC III: equates to a complete hemipelvis separation (but without vertical displacement);
unstable
pubic diastasis >2.5 cm
disruption-diastasis of both anterior and posterior sacroiliac joint ligaments with dislocation

10. Lateral compression (LC)
Most common type.
● LC I: stable
○ oblique fracture of pubic rami
○ ipsilateral anterior compression fracture of the sacral ala
● LC II: rotationally unstable, vertically stable​
○ fracture of pubic rami
○ posterior fracture with dislocation of the ipsilateral iliac wing
(crescent fracture)
● LC III: unstable
○ ipsilateral lateral compression (LC)
○ contralateral anteroposterior compression (APC)

11. Vertical shear (VS)
Most severe and unstable type with a high association of visceral injuries.
● vertical displacement of hemipelvis, pubic and sacroiliac joint
fractures
Combined
Stability depends on the individual components of this injury.
● complex fracture, including a combination of anteroposterior
compression (APC), lateral compression (LC), and/or vertical shear
(VS)

12. Clinical features And Clinical Assessment
-Features of pelvis should be suspected in every patient with serious abdominal
injury or lower limb injury
-H/o RTA, Fall from a height or Crush Injury
Sever pain, Swelling and bruises in lower abdomen, perineum,thigh, scrotum or
vulva
-Extravasations of Urine
-Symptoms and sign of bleeding and Hemorrhagic shock.
-Tenderness all over the pelvis bone Especially the pelvis bone when attempt to
compress or distract the pelvis
-Tender abdomen due to bleeding or Intrapelvic structure Injuries.
-Rectal Examination should be done in every case
-

14. Radiography
1.plain radiography: 5 views are necessary
1.Anteroposterior view.
2.Pelvic inlet view in which the tube is cephalad to the pelvis and
tilted 45° downwards.
3.Pelvic outlet view in which the tube is caudad to the pelvis and
tilted 45° upwards.
4.Right oblique view.
5.Left oblique view.

16. CT SCAN
CT scan gives accurate details and much
information about the injury.
CT scanning is imperative in any suspected
pelvic injury or in suspected sacral fractures.
l2mm to 3mm axial sections are
recommended.

18. Urethrography for diagnosis of urethral
injury

19. Management
Early management
Treatment should not await full and detailed
diagnosis. Doctor should move according to
the priority of life saving measures with the
already available information.Six questions
must be asked and the answers acting upon
as they emerge:

20. 1. Is there a clear airway?
2.Are the lungs adequately ventilated?
3.Is the patient losing blood?
4.Is there an intra abdominal injury?
5.Is there a bladder or urethral injury?
6.Is the pelvic fracture stable or not?

21. Management Of Severe Bleeding
Treatment of shock – Rapid fluid resuscitation,blood transfusion.
Wrapping of pelvis with sheets with internal rotation & slight flexion of the
knees.
Anterior external fixation,pelvic C- clamp,pneumatic antishock
garments.
Pelvic packing & angiographic embolisation if required.

22. Management Of Urethral Injuries
Control of Contamination
Laparotomy If Required

23. Treatment Of fracture
Isolated fracture and minimally displaced fracture (LC 1 & APC1) Need
only bed rest with Lower Limb Traction.
More severe pelvic fractures (LC 2 & APC2) with pubic symphysis
diastasis of more than 2.5 cm,pubic rami fractures with more than 2 cm
displacement or other rotationally unstable fractures with limb length
discrepancy of more than 1.5 cm require surgical intervention either by
external fixation or by closed reduction and internal fixation.

28. AP-III and VC are the most dangerous and
the most difficult to treat. These are unstable
fractures and needs reduction and fixation by
either external fixation or plate and screws.

32. Secondary Complications
1.Sciatic nerve injury.
2.Urogenital problem like stricture,
incontinence and impotence.
3.Persistent sacroiliac pain due to unstable
pelvis.