Pelvic Trauma and acetabular fracture imaging and classification

1. Pr C Cyteval
Montpellier University
Montpellier
PELVIS TRAUMA
and
ACETABULAR TRAUMA

2. • pelvic ring
• 3 points of weakness
Iliopubic Complex
ilio-ischiatic complex
Acetabulum

3. RX Rays
CT scan+++:
- Stable / unstable lesions
- Seek for less visible lesions
- Complications

4. • stable lesions

5. Fractures of the iliac wing

6. Fractures of the anterior arch

7. Osseous pullout
• teenagers

8. • unstable lesions

9. Medial Rotation
• Vertical shear:
vertical compression
hemipelvis ascent
• Horizontal displacement
Lateral rotation "Open book“
Unstable lesions

10. Vertical shearing

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

12. 3 complications
• Neurological Complications

13. • Vascular complication

15. • Urologic complications

16. ACETABULUM
1 2
1- Post ilioischiatic column
2- Anterior iliopubic column
3
3- noman’s land

17. CLASSIFICATION ( Letournel et Judet )
• Simples
Fractures
25 %
10 %15 %
6 %
2 %

18. POSTERIOR WALL FRACTURE
Secondary to posterior femoral dislocation
spontaneously reduced
• Displacement
• Incarcerated fragment
• articular Congruence
• Osteochondral impaction

19. 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.

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

21. • 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

22. COLUMN FRACTURE
• Anterior column:
Often assiociated with a post.column F
or transversal F
• Posterior column :
Risk of injury to the sciatic nerve!

24. 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)

27. CLASSIFICATION ( Letournel et Judet )
• Complex Fractures
9 %
5 %
3 %
19 %
3 %

28. 2D reformation
6 vues
Other lesions of the pelvic
Help for the surgeon
For displacement

29. Incarcetated Fragment
Total decoaptation of the femoral head during
surgery needed (not systematic)
Especially in case of post dislocation

30. 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

31. Osteo-chondral Impaction
Femoral head Acetabulum
Usually compromises good congruence

32. Associated Fractures
Acetabulum, sacrum and pubic disjunction

34. Management
No impaction
Good congruence
Orthopedic treatment
Impaction
Bad congruence
Young patient Old patient
Surgery Prosthesis

35. ACETABULAR TRAUMA
X Rays? CT scan+++ :
• analysis:
– Displacement
– Incarcerated fragments
– Congruence
– Osteochondral impaction
• Associated hidden lesions
• Complications : Vascular, neurological,
bladder