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Pelvic Mythology

HC Sagi, MD FACSProfessor and Chief of Trauma

University of Cincinnati

MYTH

CLASSIFYING A PELVIC FRACTURE BASED

ON PLAIN RADIOGRAPHS AND COMPUTED

TOMOGRAPHY WILL TELL US IF A PELVIC

FRACTURE IS STABLE OR UNSTABLE

58 year old lady falls off of horse. Pa

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8 month F/U Non-operative RxDyspareunia and Recurrent UTI

How do we prevent this?

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True or False?

CLASSIFYING A PELVIC FRACTURE BASED

ON PLAIN RADIOGRAPHS AND COMPUTED

TOMOGRAPHY WILL TELL US IF A PELVIC

FRACTURE IS STABLE OR UNSTABLE

ARE THESE THE SAME INJURY?

ARE THEY CLASSIFED APC-1, APC-2 (or something else…)?

ARE THESE THE SAME INJURY?

ARE THEY REALLY BOTH CLASSIFED LC-1 (or something e

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The Impetus…

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METHOD OF EUA

• 15 distinct fluoroscopic images:

– Static, ER, IR, Push-Pull– AP, Inlet, Outlet projections

AP COMPRESSION - ER

LATERAL COMPRESSION - IR

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BILATERAL PUSH AND PULL

50% = No fixation (True APC-1)

50% = Anterior fixation (Occult APC-2)

APC INJURY

APC-1?

50% = No fixation (True APC-1)

50% = Anterior fixation (Occult APC-2)

APC INJURY

APC-1?

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60% = APC-2a (Ant ORIF ) 40% = APC-2b (Ant + Post

ORIF)

APC INJURY

APC-2?

60% = APC-2a (Ant ORIF ) 40% = APC-2b (Ant + Post

ORIF)

APC INJURY

APC-2?

EXAMPLE #1

NO BINDER

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Management?

EUA (Push/Pull)

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EUA (IR/ER)

32Is Anterior Only Fixation Adequate?

EXAMPLE #2

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Maximum ER

pull

push

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pull

push

LC INJURY

INCOMPLETE LC-1?

?

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LC INJURY

INCOMPLETE LC-1?

?

LC INJURY

INCOMPLETE LC-1?

?

?

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LC INJURY

– 63% -- No fixation (LC-1a)

– 37% --Anterior / Posterior fixation (LC-1b)

INCOMPLETE LC-1?

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Example #1

Incomplete Sacral Fracture

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EX

BUT…

Example #2

Injury CT

Incomplete Sacral Fracture?

Static Inlet View

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Inlet – Lateral Compression

Post Fixation

• Static radiographs inadequately define pelvic ring instability:Some APC-1 ---> APC 2 (and need fixation)Some APC-2 ---> Fl/Ex too muc (need post

ORIF)Some LC-1 ---> IR too much (?)

Poor functional outcomes may be due (in part) to undiagnosed instability.

Conclusion

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Conclusion

• Pelvic EUA helps to confirm stability and avoid unnecessary transfers for surgery… for me.

• Pelvic EUA is an important diagnostic tool to guide treatment and fixation…for me.

Conclusion

Existing Classification Systems are OBSOLETE and cannot help to decide

treatment with modern strategies.

Conclusion

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Existing Classification Systems are OBSOLETE and cannot help to decide

treatment with modern strategies.

Conclusion

X

ασπρο πατο!!

ευχαριστώ