Emergency and Trauma of the Pelvic Ring

Abstract

Pelvic ring fractures are a common consequence of high-energy blunt trauma with a high rate of morbidity and mortality due to associated injuries, especially to the head, pelvic viscera, and vascular structures. The Young and Burgess classification system is the most widely utilized for categorizing pelvic ring injuries and assessing stability. The initial identification of these injuries often comes from an anteroposterior radiograph; however, computed tomography examination with three-dimensional volume-rendered reconstructions represents the reference standard and has essentially eliminated the requirement for inlet and outlet views. The appropriate treatment depends on a good knowledge of the anatomy and biomechanics of the pelvis. This review article underlines the importance of the integrity of ligaments to pelvic stability and describes the patterns of pelvic ring injuries and their associated mechanisms of injury.

Keywords

pelvic ring - pelvic ring fractures - pelvic ring radiography - pelvic ring computed tomography

• References

• 1 Schmal H, Markmiller M, Mehlhorn AT, Sudkamp NP. Epidemiology and outcome of complex pelvic injury. Acta Orthop Belg 2005; 71 (01) 41-47
• 2 Durkin A, Sagi HC, Durham R, Flint L. Contemporary management of pelvic fractures. Am J Surg 2006; 192 (02) 211-223
• 3 Figler BD, Hoffler CE, Reisman W. , et al. Multi-disciplinary update on pelvic fracture associated bladder and urethral injuries. Injury 2012; 43 (08) 1242-1249
• 4 Agnew SG. Hemodynamically unstable pelvic fractures. Orthop Clin North Am 1994; 25 (04) 715-721
• 5 Tile M, Pennal GF. Pelvic disruption: principles of management. Clin Orthop Relat Res 1980; (151) 56-64
• 6 Riemer BL, Butterfield SL, Diamond DL. , et al. Acute mortality associated with injuries to the pelvic ring: the role of early patient mobilization and external fixation. J Trauma 1993; 35 (05) 671-675 ; discussion 676–677
• 7 Tile M. Pelvic fractures: operative versus nonoperative treatment. Orthop Clin North Am 1980; 11 (03) 423-464
• 8 McCormack R, Strauss EJ, Alwattar BJ, Tejwani NC. Diagnosis and management of pelvic fractures. Bull NYU Hosp Jt Dis 2010; 68 (04) 281-291
• 9 Khurana B, Sheehan SE, Sodickson AD, Weaver MJ. Pelvic ring fractures: what the orthopedic surgeon wants to know. Radiographics 2014; 34 (05) 1317-1333
• 10 Yoshihara H, Yoneoka D. Demographic epidemiology of unstable pelvic fracture in the United States from 2000 to 2009: trends and in-hospital mortality. J Trauma Acute Care Surg 2014; 76 (02) 380-385
• 11 Dente CJ, Feliciano DV, Rozycki GS. , et al. The outcome of open pelvic fractures in the modern era. Am J Surg 2005; 190 (06) 830-835
• 12 Gabbe BJ, de Steiger R, Esser M, Bucknill A, Russ MK, Cameron PA. Predictors of mortality following severe pelvic ring fracture: results of a population-based study. Injury 2011; 42 (10) 985-991
• 13 Gänsslen A, Giannoudis P, Pape HC. Hemorrhage in pelvic fracture: who needs angiography?. Curr Opin Crit Care 2003; 9 (06) 515-523
• 14 Tile M, Hearn T, Vrahas M. Biomechanics of pelvic ring. In Tile M, Helfet DL, Kellam JF. , eds. Fractures of the Pelvis and Acetabulum. 3rd ed. Baltimore, MD: Williams & Wilkins; 2003: 32-45
• 15 Pekmezci M, Kandemir U, Toogood P, Morshed S. Are conventional inlet and outlet radiographs obsolete in the evaluation of pelvis fractures?. J Trauma Acute Care Surg 2013; 74 (06) 1510-1515
• 16 American College of Surgeon Committee on Trauma. ATLS: Advanced Trauma Life Support for Doctors (Student Course Manual). 8th ed. Chicago, IL: American College of Surgeons; 2008
• 17 Slater SJ, Barron DA. Pelvic fractures: a guide to classification and management. Eur J Radiol 2010; 74 (01) 16-23
• 18 Gary JL, Mulligan M, Banagan K, Sciadini MF, Nascone JW, OʼToole RV. Magnetic resonance imaging for the evaluation of ligamentous injury in the pelvis: a prospective case-controlled study. J Orthop Trauma 2014; 28 (01) 41-47
• 19 Jeske HC, Larndorfer R, Krappinger D. , et al. Management of hemorrhage in severe pelvic injuries. J Trauma 2010; 68 (02) 415-420
• 20 Marzi I, Lustenberger T. Management of bleeding pelvic fractures. Scand J Surg 2014; 103 (02) 104-111
• 21 Young JW, Burgess AR, Brumback RJ, Poka A. Pelvic fractures: value of plain radiography in early assessment and management. Radiology 1986; 160 (02) 445-451
• 22 Marsh JL, Slongo TF, Agel J. , et al. Fracture and dislocation classification compendium—2007: Orthopaedic Trauma Association classification, database and outcomes committee. J Orthop Trauma 2007; 21 (10, Suppl) S1-S133
• 23 Pennal GF, Tile M, Waddell JP, Garside H. Pelvic disruption: assessment and classification. Clin Orthop Relat Res 1980; (151) 12-21
• 24 Tile M. Acute pelvic fractures: I. Causation and classification. J Am Acad Orthop Surg 1996; 4 (03) 143-151
• 25 Leone A, Costantini AM, Magarelli N, Bonomo L. . Imaging of pelvic ring fractures. European Congress of Radiology (ECR), 2010 Vienna. Presentation number: C-2165. DOI:10.1594/ecr2010/C-2165. Poster score:195