Open book pelvic fracture with diastasis

Complications may include internal bleeding, injury to the bladder, or vaginal trauma common causes include falls, motor vehicle collisions, a vehicle hitting a pedestrian, or a direct crush. He was hemodynamically stable on admission, and multiple injuries were identified including an unstable open book pelvic ring disruption right, nondisplaced superior and inferior ramus fractures, a symphyseal diastasis of 4 cm and complete disruption of the right sacroiliac joint. Pelvic fracture overview everything you need to know. Pelvic fractures pediatric orthopaedic society of north. In type b1, open book symphysial diastasis is less than 2. Open book pelvic fracture with soft tissue serious damage in a child article pdf available in strategies in trauma and limb reconstruction 101 march 2015 with 433 reads. Isolated iliac wing fractures, avulsion fractures of the iliac spines or ischial tuberosity, nondisplaced pelvic ring fractures. The authors concluded that open book fractures create an increase of pelvic volume that facilitates blood diffusion from the pelvic vessels.

Young and burgess classification pelvic fractures ap compression apc direct anterior force type 1. The mortality rate is 1525% for closed pelvic fractures and as much as 50% for open pelvic fractures. Open book fracture with symphyseal diastasis diastasis 2 cm demands anterior external fixation with possible fixation for the posterior injury. Open reduction and internal fixation orif is usually indicated when diastasis of the pubic symphysis exceeds 2. Operative treatment for incomplete disruption posterior. The definitive treatment of open book fractures is usually achieved by open reduction, internal fixation or external fixation. Consecutive open book fracture model, subsequently simulating two distinct injury severity patterns, corresponding to ota classifications 61b1 and 61c1. Displaced pelvic fractures can be stabilized temporarily by simple means during the initial evaluation and transportation. Diastasis of pubic symphysis with complete disruption of sacroiliac joint and posterior pelvic ring ligaments. The bony pelvis provides protection to the lower abdominal and genitourinary tract as well as the great vessels of the pelvic floor and. It usually corresponds to tile b injury, in which the posterior ligamentous structures remain intact resulting in rotational instability of the pelvis. A pelvic fracture is a break of the bony structure of the pelvis. Pdf open reduction and internal fixation of a traumatic. Anterior pelvic injuries wheeless textbook of orthopaedics.

Noninvasive reduction of openbook pelvic fractures by. Vertical shear displacement of the hemipelvis superiorly or posteriorly involving diastasis of the pubic symphysis, rami fractures, displacement of the sacroiliac joint, andor fractures of the iliac wing or sacrum. A prototype pelvic strap was applied subsequently at three distinct transverse levels around the pelvis. Type b fracture is further divided into three subtypes i. Openbook fractures of the pelvis are uncommon during childhood and require urgent treatment from the association with other abdominal, vascular or nervous injuries. External rotation of the hemipelvis requires binding and likely surgical fixation. Pelvic fracture in emergency medicine differential diagnoses. Classification of pelvic fractures litfl ccc trauma. Pdf openbook pelvic fracture with soft tissue serious. A sheet can be tied around the pelvis, or the legs can be tied together in an internally rotated position to approximate an anterior pelvic diastasis. Pelvic vertical shear fracture open book fracture pubic symphysis diastasis open book pelvic fracture radiographic views for acetabular fractures acetabular fracture of posterior column posterior acetabular and femoral head fractures anterior acetabular wall fracture anterior acetabular column fracture.

While some open book injuries with slight symphyseal diastasis do not need surgery, there is no specific width that separates stable from unstable injuries. The majority of these fractures are what is commonly referred to as an open book pelvic fracture given the opening of the pubic symphysis anteriorly. Patients who survive an open pelvic fracture are often left with longstanding or permanent disabilities which can be challenging to any healthcare system. These methods rely on immobilization and partial reduction of displacement. Open book pelvic injuries result from an anteroposterior compression injury to the pelvis and result in a combination of ligamentous rupture andor fractures to both the anterior and posterior arches 5. This includes any break of the sacrum, hip bones ischium, pubis, ilium, or tailbone. Open book fractures, lateral compression fractures, and buckethandle fractures. Pelvic fractures are a special consideration for dpl because there. Karam introduction diastasis of the pubic symphysis is often part of a complex injury to the pelvic ring. Closeup view of the pelvis shows widening of both sacroiliac joints white arrows, right greater than left, and marked widening of the symphysis pubis red arrow. However, haemorrhage is usually the leading cause of death. Circumferential pelvic compression was induced by gradual tensioning of the strap to attempt complete reduction of the symphysis diastasis. Open reduction and internal fixation of a traumatic diastasis of the pubic symphysis.

Surgery if symphasis pubic diastasis is more than 2. Operative treatment absolute indication relative indication open pelvic fractures open book fracture or unstable fracture associated with hemodynamic instability symphysis diastasis 2. In 60%, a laceration of the iliolumbar vein occurred after 5 cm of pubic diastasis. Principle of treatment theoretically, due to the intact posterior hinge, open book injuries can be stabilized by reducing and fixing the anterior arch disruption. Diastasis of the symphysis pubis rarely coexists with fractures of the pubic rami 3,4.

Joint replacement procedures will be discussed in the second section. In type b2, open book symphyseal diastasis is greater than 2. Openbook pelvic fractures associate a diastasis andor a fracture of the pubic rami with a posterior pelvic disruption of the sacroiliac joint. Open book pelvic injury radiology reference article radiopaedia. An immature pelvis with open triradiate cartilage most commonly sustains fractures of the pubic rami and iliac wings. Both rami fractured on both sides or both rami on one side with pubic.

One specific kind of pelvic fracture is known as an open book fracture. Diastasis of symphysis pubis and both sacroiliac joints sprung pelvis. However, the mortality still remains significantly high. Application of multiplanar external fixator to pelvis and then external fixation of pelvic ring fracture, specifically external fixation of the sacral fracture, left acetabular fracture, pubic symphysis diastasis and pubic ramus fracture. Anatomical consequences of openbook pelvic ring disruption. Multiple fx of pelvis w stable disrupt of pelvic ring, init. Open book pelvic injury radiology reference article. Internal fixation is performed to relieve pain and improve stability of the anterior pelvic. Open book pelvic injuries are most often the result of highenergy trauma and are. Independent experimental variables of the pelvic strap. Fracture of left lateral edge of the lower sacruum. Open book pelvic injuries are most often the result of highenergy trauma and are associated with significant morbidity and mortality due to associated vascular injuries pathology. Openbook pelvic fracture with soft tissue serious damage in a child. Demonstration of the correct placement of a pelvic binder for an open book pelvic fracture with diastasis of the pubic symphysis.

The pelvis and hips introduction this chapter will address clinical and imaging aspects of orthopaedic procedures in the pelvis and hips. The pelvic ring is supported by ligaments that are stronger and more numerous in the posterior segment, where load is transferred from spine to lower limbs, while the pubic symphysis acts as a strut to provide pelvic ring stabilization. Open book fractures of the pelvis are uncommon during childhood and require urgent treatment from the association with other abdominal, vascular or nervous injuries. Reduce anterior symphyseal diastasis diastasis of symphysis pubis and both sacroiliac joints sprung pelvis. A sentence in the body of the report indicates this is an open book pelvic fracture. In this kind of injury, the left and right halves of the pelvis are separated at front and rear, the front opening more than the rear, i. This is often the result from a heavy impact to the groin pubis, a common motorcycling accident injury. The case discussed is an openbook fracture type b1, tile classification associated with triradiate cartilage injury type i, salterharris classification in an 11yearold. Openbook fractures of the pelvis are uncommon during childhood and require. When managing open pelvic injuries, it is essential to first resuscitate the patient and assess their airway, breathing, circulation and disability, in accordance with the advanced trauma life support guidelines. Treatment is conservative if spontaneous reduction of type b2 pubic symphysis diastasis 2.

Diastasis widening of the pubic symphysis greater than 1 cm can represent instability with diastasis greater than 2. Bladder incarceration following anterior external fixation. Some have argued that in the stable open book pelvic disruption where the posterior pelvic integrity is maintained, only 1 plate full text plating a pubic diastasis following a pelvic ring. Open pelvic fractures account for 24% of all pelvic fracture and are lifethreatening injuries that provide a challenge to any trauma team. They observed that each millimeter of pubic diastasis or inferomedial pubic bone fracture fragment displacement was associated with a 10% increased risk of urethral injury. Adolescents with a closed triradiate cartilage most commonly sustain fractures of the acetabulum, diastasis of the pubic symphysis, and separation of the sacroiliac joints. The case discussed is an open book fracture type b1, tile classification associated with triradiate cartilage injury type i, salterharris classification in an 11yearold.