【正文】 骨盆及髖臼骨折 Fractures of Pelvis and Acetabulum 王 滿 宜 北京積水潭醫(yī)院 Fractures of Pelvis ? Pelvic pathology: Undisplaced/minmally displaced/displaced: Stable fracture Partially stable fracture (rotational) Completely unstable (rotational and vertically/translationally) Isolated iliac wing fractures Undisplaced pubic ramii fractures Transverse fractures of sacrum below pelvic ring Os coccygis fractures All pelvic ligaments intact! ? Unstable pelvic fractures: Partially stable: Rotationally unstable: External/internal rotation (lateral pression) Flexion/extension Abduction/adduction Completely unstable: Rotationally and vertically (translationally) unstable ? Partially stable pelvic fractures: Rotationally unstable: Open book fractures external rotation Lateral pression fractures internal rotation ? External rotation: Mechanisms of injury: Posterior crush Direct pressure ASIS External rotation through femur(s) Rupture symphysis/sacrospinous lig./anterior sacroiliac lig Always posterior and interosses sacroiliac ligaments intact! ? External rotationally unstable fracture: Partially stable pelvic fractures: Disruption of symphysis only: Slight external rotation Widening of symphysis max. cm = Open book injury ? External rotationally unstable fractures: Partially stable pelvic fracture: Disruption of symphysis, sacrospinous ligament and anterior sacroiliac ligament: Open book injury Massive external rotation PSIS abuts sacrum: External rotational instability ? External rotationally unstable fractures: Partially stable pelvic fracture: Disruption of symphysis, sacrospinous ligament, all sacroiliac ligaments: Open book injury with: Massive external rotation Flexion Transition to vertical/translational instability ? Internal rotation: Mechanisms of injury: Direct pressure to iliac crest Force against greater trochanter femoral head acetabulum Force parallel to sacral plane through (s) ? Internal rotationally unstable fractures: Partially stable pelvic fracture: Crush of lateral sacrum Disruption of posterior sacroiliac ligament Always anterior lesion: Transsymphyseal Transpubic Lateral pression injury Always pelvic floor intact! ? Vertical shear: Mechanisms of injury: Force perpendicular to: Sacral plane SIjoint plane (s) ? Rotationally and vertically (translationally) unstable fractures: Completely unstable pelvic fractures: Always plete disruption of: Posterior plex Pelvic floor Anterior plex Completely unstable fracture ? Rotationally and vertically (translationally) unstable fractures: Completely unstable pelvic fracture: Always plete disruption of: Posterior plex: Ligamentous SIjoint fracturedislocation Transiliac fracture Transalar/transforaminal sacral fracture S1/S2 transverse fracture Anterior plex! ? Applicable classifications: TILE 1984/1991 CCF AO/ASIF 1996 OTA modification of CCF AO/ASIF 1996 ? Additional terms/definitions: Simple = unplicated pelvic fracture: Soft tissues around pelvis closed No laceration: GUI/Viscera Complex pelvic fracture: Soft tissues around pelvis open Involvement of: GUI and/or viscera Traumatic hemipelvectomy ? Type A fractures: stable Type B fractures: partially stable Type C fractures: pletely unstable TILE 1984/1991 ? Type A stable pelvic ring fractures: Type A1: Avulsion of the innominate bone Type A2: Stable iliac wing fracture or stable minimally displaced ring fractures Type A3: Transverse fractures of the