Ucsf: Video E 48 Part 6 Msk Skeletal Trauma (Learning Radiology- Pelvic Trauma)

Front 1

What makes up the anterior arch of the pelvis

Back 1

the ischium and pubic bone

Front 2

What makes up the posterior arch of the pelvis

Back 2

the sacrum and pubic bone

Front 3

What is an anterior arch fracture of the pelvis

Back 3

any fracture of the ischium or pubic bone (think of them together forming one ring and dont be confused because they form a ring themselves)

Front 4

What percent of pelvic fractures are considered stable

Back 4

66%

Front 5

What is considered a stable fracture

Back 5

a single break in ring or a peripheral fx

Front 6

What are unstable fractures

Back 6

fractures of both the anterior and posterior arches (33%)

Front 7

What are the stable pelvic fractures
(4)

Back 7

solitary ischial ramus fracture
unilateral fracture of both rami (superior pubic ramus and ishiopubic ramus)
iliac wing fractures
isolated sacral fractures

Front 8

What is another name for a iliac wing fracture

Back 8

Duverny fracture

Front 9

What is a major point of confusion when discussing ramus of the pelvis

Back 9

When they say pubic ramus it is implied to means superior pubic ramus (the of the ring around the obturator foramen)

Even though technically a pubic ramus fracture can be on the bottom of the ring of the obturator (the inferior pubic ramus portion located medially)

Front 10

What is the mc pelvic fracture

Back 10

solitary fracture of the ischial ramus or inferior pubic ramus

(this can happen in both areas and so I think a better name would be a solitary fracture of the ischiopubic ramus)

Front 11

Is a solitary fracture of the ischial ramus stable

Back 11

yes

Front 12

What population commonly get ischial ramus fractures

Back 12

osteoporotic females (insufficiency fracture)

Front 13

Another point of confusion: 'a solitary fracture of both rami' really means a fracture of the top of the ring of the obturator foramen and the bottom of the ring of the obturator foramen. What would be a better name

Back 13

a solitary fracture of both the superior pubic ramus and the ischiopubic ramus

OR

a solitary fracture of the superior pubic ramus AND the inferior pubic ramus OR the ischial ramus

Front 14

Is a solitary fracture of both rami a stable fracture

Back 14

yes

Front 15

What is the cause of an iliac wing fracture (duverny) fracture

Back 15

direct lateral compression

Front 16

What is a potential complication of an iliac wing fracture

Back 16

fracture can perforate bowel

Front 17

What is the orientation of a isolated sacral fracture

Back 17

transversly oriented

Front 18

What view is best to detect an isolated fracture of the sacrum

Back 18

lateral which may show angulation of sacrum or coxcy

Front 19

What is the direction of fractures associated with other sacral fractures

Back 19

vertically

Front 20

What are the 4 unstable fractures of the pelvis

Back 20

malgaigne (Mal-gain-e)
straddle
pelvic dislocation
bucket handle fracture

Front 21

What is the mc unstable pelvic fracture

Back 21

malgaigne (mal-gain-e)

Front 22

What percent of all pelvic fractures are malgaine

Back 22

14%

Front 23

What is the mechanism by which a malgaigne fracture occurs

Back 23

vertical shearing

Front 24

What happens to the hip in a malgaigne fracture

Back 24

it is commonly displace upward

Front 25

Where is the MC fracture line of the pelvis in a malgagne fracture

Back 25

the pubic rami (superior and ishiopubic ramus) and the sacroiliac joint

Front 26

What makes up the 3 sacral lines seen on AP frontal view of the pelvis

Back 26

the roof the the 1st, 2nd and 3rd sacral foramina

Front 27

What should always be checked in a AP of the pelvis

Back 27

symmetry and continuity of the sacral lines from one side to the other

Front 28

Are straddle fractures stable

Back 28

no

Front 29

What is a straddle fracture

Back 29

a fractue of the superior pubic ramus and the ischiopubic ramus on both sides

Front 30

What happens to the fracture fragments in a straddle injury

Back 30

the central portion fracture is elevated

Front 31

What are straddle injuries associated with

Back 31

urethral injuries (20%)

Front 32

What is another name for a pelvic dislocation

Back 32

a sprung pelvis

Front 33

What 2 unstable fractures are associated with GU injury

Back 33

pelvic dislocation and straddle fracture

Front 34

What is the normal measurement of the SI joint

Back 34

1-4mm

Front 35

What is the normal measurement of the symphysis pubis

Back 35

5mm

Front 36

What happens to the size of the symphysis pubis and SI joints in a sprung pelvis

Back 36

they increase in size

Front 37

What is a bucket handle fracture

Back 37

fracture of the anterior arch and the contralateral posterior arch

Front 38

Is a bucket handle fracture common

Back 38

no, it is rare

Front 39

What is the posterior urethra

Back 39

the membranous or prostatic urethra

Front 40

Where do GU injuries tend to occur from pelvic fractures

Back 40

the posterior urethra

Front 41

If someone has a straddle injury or a sprung pelvis what should be done prior to insertion of a foley to prevent further injury

Back 41

a retrograde urethrogram

Front 42

What is a an open book fracture

Back 42

a straddle injury in the front and Bilateral SI joint disocciation in the posterior arch

Front 43

Besides posterior urethral injuries what other GU injury may occur with a sprung pelvis or a straddle fracture

Back 43

a ruptured bladder

Front 44

What is more common an extraperitoneal or intraperitoneal rupture of the pelvis

Back 44

extraperitoneal (80%)

Front 45

Where does the contrast remain in an extraperitoneal rupture of the bladder

Back 45

adjacent to the bladder

Front 46

What happens to the contrast in an intraperitoneal rupture

Back 46

the dome is damaged and the contrast flows freely

Front 47

Where is the posterior rim of the acetabulum, roof of the acetabulum, ilioischial line, iliopectineal line, teardrop

Back 47

Front 48

What are the 2 columns of the acetabulum

Back 48

the anterior and posterior column

Front 49

What makes up the anterior column of the acetabulum
5

Back 49

Anterior column includes
1- anterior aspect of the iliac Roof of acetabulum
wing
2- pelvic brim
3- superior pubic ramus
4- anterior wall of acetabulum
5- teardrop.

Front 50

t

Back 50

T

Front 51

What is another name of the iliopectineal line

Back 51

the ileal pubic line

Front 52

What represents an injury to the anterior column

Is a tear fracture anterior or posterior

Back 52

injury to the iliopubic (iliopectineal line)

tear fractures are anterior column fractures

anterior acetabular wall

Front 53

What represents the posterior column on a radiograph

What makes up the medial line of the acetabular tear drop

Back 53

the ilioischial line
Posterior acetabular wall

The ilioischial line

Front 54

What is the most common mechanism for a posterior column injury

Back 54

anterior force on femoral head

Front 55

What is the most common mechanism for a anterior column injury

Back 55

Posterior force on femoral head

Front 56

What makes up the posterior column

Back 56

posterior ilium, posteriorwall of acetabulum, ischium, medial acetabular wall

Front 57

Where is the iliopubic (iliopectineal) line of the anterior column

Back 57

L1

Front 58

Where is the anterior rim of the acetabulum

Back 58

L2

Front 59

Where is the ilioischial line and what forms this

Back 59

L3 (, formed by the posterior portion of the quadrilateral plate (surface) of the iliac bone)

Front 60

Where is the posterior rim of the acetabulum

Back 60

L4

Front 61

Where is the tear drop and what forms it

Back 61

L5 (formed by the medial acetabular wall, the acetabular notch, and the anterior portion of the quadrilateral plate)

Front 62

What does the iliopectineal line look like on plain film

Back 62

Front 63

What does the iliopectineal line look like on plain film

Back 63

Front 64

What does the a fracture of the anterior lip and teardrop look line on plain film and what does it indicate

Back 64

Discontinuity of the anterior lip suggests an anterior wall fracture

Front 65

What does the posterior lip of the acetabulum look like on plain film

Back 65

If there is discontinuity there is a fx of the posterior wall of the acetabulum

Front 66

What does the dome of the acetabulum look like on plain film

Back 66

Front 67

What is the quadrilateral plate of the hip

Back 67

Quadrilateral plate is the junction where 3 parts of innominate bone, the Ilium, the Ischeum and the Pubis meet.

Front 68

anatomy

Back 68

Front 69

What is the ilioischial line

Back 69

the posterior aspect of the acetabulum and runs from the ilium to the ischium

Front 70

What percent of pelvic fractures involve the acetabulum

Back 70

20%

Front 71

What additional views besides AP are used to look at acetabular fractures

Back 71

judget views (45 degree oblique views)

Front 72

What view is good for looking at acetabular postererior displacements and symphysis diastasis

Back 72

inlet view (AP view with the x-ray beam angled 20 degrees caudal)

Front 73

What view is good to look at vertical shifts of bones of the pelivis and the sacrum

Back 73

outlet views (AP pelvis with beam tilted 35 degrees cephalad)

Front 74

What 4 types of acetabular fxs

Back 74

posterior rim fractures
transverse acetabular fractures
anterior column fractures
posterior column fractures

Front 75

What percent of acetabular fractures are posterior rim fxs

Back 75

22%

Front 76

What is a common cause of a posterior rim fx

Back 76

posterior disloacation of the hip (MVA)

Front 77

What is another name for the hip bone

Back 77

inominate bone

Front 78

Is the hip bone a group of bones

Back 78

yes

Front 79

What is the definition of the hip bone (innominate bone)

Back 79

either of the two bones (2 halfs of the pelvis) that form the sides of the pelvis, consisting of three fused components, the ilium, ischium, and pubis

Front 80

What is an transverse acetabular fracture

Back 80

a transverse fracture through the acetabulum that seperates the hip into 2 halves (4% of acetabular fractures)

Front 81

What lines will be disrupted in a transverse acetabular fracture

Back 81

the iliopubic and ilioischial lines

Front 82

What can happen to the femoral head in a severe case of a transverse acetabular fracture

Back 82

central dislocation (femoral head is in the middle of the pelvis)

Front 83

What percent of acetabular fractures are anterior column fxs

Back 83

4%

Front 84

What line is disrupted in a anterior acetabular fracture

Back 84

the iliopubic

Front 85

Can an acetabular fracture lead to central dislocation of the femoral head

Back 85

yes

Front 86

What is more common; fx of both columns or isolated column fractures

Back 86

fracture of both columns

Front 87

What does an anterior column fx look like on CT

Back 87

Front 88

Visualize how the anterior column fracture on the previous slide disrupts the iliopubi (iliopectineal line)

Back 88

Front 89

Now look at this lateral and visualize the fracture through the pubic bone

Back 89

Front 90

What is more common anterior or posterior column fractures

Back 90

anterior column (4%)
posterior column (2%)

Front 91

What are posterior colum fractures associated with

Back 91

posterior dislocation of the femoral head

Front 92

What are 4 most common avulsion fractures of the pelvis

Back 92

ASIS
AIIS
Ischial tuberosity
Pubis

Front 93

What are the common demographic of people with avulsion fractures

Back 93

athletic males in puberty

Front 94

What are apophyses

Back 94

natural protuberance from a bone for the attachment of muscles.

Front 95

What is the most common apiphyse to be avulsed

Back 95

the ischial tuberosity

Front 96

What muscle causes an avulsion fracture of the ischial tuberosity

Back 96

the hamstrings

Front 97

What do avulsed ischial tuberosity fractures look like upon healing

Back 97

lots of callous formation leading to marked enlargement of the ischial tuberiosity

Front 98

Where is the ischial tuberosity on AP plain film

Back 98

Front 99

Where is the ASIS on plain film

Back 99

Front 100

Where is the AIIS on plain film

Back 100

Front 101

What muscle inserts into the AIIS

Back 101

rectus femoris

Front 102

What is the second most common avulsion fracture of the pelvis

Back 102

AIIS and ASIS are tied

Front 103

What muscle inserts to the ASIS

Back 103

sartorius

Front 104

Where is the lesser and greater trochanters of the femur

Back 104

Front 105

What muscle inserts into the lesser trochanter

Back 105

iliopsoas

Front 106

What muscle inserts into the greater trochanter

Back 106

gluteal muscles

Front 107

What muscles insert into the iliac creast

Back 107

abdominal muscles

Front 108

What muscles attach to symphysis

Back 108

the abductor group of muscles

Front 109

What is the most common artery to be lacerated from pelvic trauma

Back 109

the hypogastric artery

Front 110

What is a clue that there may be a pelvic hematoma

Back 110

displacement of the bladder

Front 111

What is the Dennis Classification of sacral fractures

Back 111

a system to determine likely hood of neuroligic injury based on the location of a vertical fracture in relation to the neural formain

Front 112

What are the 3 zones of Dennis classification of fracture

Back 112

Front 113

What is a zone 1 dennis classification fracture of the sacrum

Back 113

I- injuries are entirely lateral to the neuroforamina: 6% neurological problem

Front 114

What is a zone 2 dennis classification fracture of the sacrum

Back 114

II- injuries involve the neuroforamina but not the spinal canal; 28% of neurological problem

Front 115

What is a zone 3 dennis classification fracture of the sacrum

Back 115

III- injuries extend into the spinal canal with primary or associated fracture lines: 57% neurological problems

Front 116

What are the most common dennis classification of vertical sacral fractures

Back 116

I>II>III