Pelvic Fractures

Published on 16/04/2015 by admin

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Last modified 16/04/2015

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17 Pelvic Fractures

Anatomy of the Pelvic Skeleton

image

Bony Pelvis and Ligaments

Coxal Bones (Os Coxae; 2)

Ilium: Parts and Landmarks

• Crest, ala (wing), fossa (of false pelvis), articular surfaces
• Posterior superior iliac spine (at posterior part of articular surface)
• Iliac tuberosity: posterior sacroiliac ligament insertion
• Anterior superior iliac spine (ASIS): sartorius, inguinal ligament insertions
• Anterior inferior iliac spine (AIIS): rectus femoris, tensor fasciae latae, iliofemoral ligament (hip joint capsule) insertions
• Greater sciatic notch: sciatic nerve, piriformis muscle, pudendal neurovascular bundle exit here
• Ilium often used for cortical and cancellous bone grafts

Ischium: Parts and Landmarks

• Ischial spine: sacrospinous (SS) ligament insertion
• Body
• Ischial tuberosity: sacrotuberous (ST) ligament, hamstring insertions
• Ischial ramus: fuses with pubic ramus to form medial rim of obturator foramen

Pubis: Parts and Landmarks

• Tubercle: medial attachment of inguinal ligament (external oblique aponeurosis)
• Superior public ramus: pecten pubis (pectineal line), along inner superior ridge
• Symphysis: midline fibrous joint of superior pubic rami
• Inferior pubic ramus
• Arch: formed by inferior pubic and ischial rami
• Acetabulum formed by portions of all three bones

image Parts: articular surface, notch, limbus (margin)
image Should fuse by age ~20 years

• Arcuate line: medial ridge running from ilium (near superior sacroiliac joint) to pecten pubis
• Linea terminalis

image Bony upper border of the true pelvis, lower border of false pelvis
image Sacral promontory to iliopectineal line: arcuate line + pectineal line

Sacrum

• Parts and landmarks: ala, sacroiliac articular surfaces, lumbosacral articular (disc) surface, promontory, fused bodies (5), anterior and posterior foramina, coccyx (~4 segments)
• Sacral canal: continuation of vertebral canal with meninges and roots of spinal cord
• Posterior: median and lateral sacral crests, superior articular facet (to L5 inferior facet), sacral hiatus (end of sacral canal, ref. for caudal anesthesia)
• Posterior and anterior sacrococcygeal ligaments

Pelvic Joints

• Sacroiliac (SI)

image Synovial joints with minimal movement
image Posterior pelvis stability, weight-bearing

• Pubic symphysis: anterior pelvis
• Coxal

image Ilium, ischium, and pubis intersect in acetabular fossa.
image Typically fused by age 20 years

Pelvic Ligaments

• Sacroiliac

image Anterior and posterior (more extensive)
image Support SI joints

• Sacrotuberous; lower border of lesser sciatic foramen
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