Pelvic Ring Injuries

Let's take our medicine today and talk about pattern recognition on something you will read a ton of while at HCMC.

Pelvic Ring Injuries!  While they can get mixed and matched, the most important thing to remember is the pelvic ring will almost always fracture/disrupt in 2 places and the pattern of injury can usually fit into 3 mechanistic categories.  Lets dive in!

LATERAL COMPRESSION INJURY

-This is the one you'll see most while reading trauma films.

-Primarily characterized by pubic rami fractures that are a usually a pretty easy catch on XR

- IMPORTANTLY what this should be telling you is to look at the sacral base, especially the ala and neuroforaminal arches as this is where the second fracture in LC type injuries often occurs.   

-Appreciate the offset of the S1 arch on the left a breathe a sigh of relief that you're going to look sharp at AM staff out.

AP COMPRESSION INJURY

-Not a lot of mystery here up front. Pubic symphysis widening should immediately make you question the integrity of the SI joints.  Appreciate the open face appearance of the sacral articular surface on the right.

-This is important to recognize as the risk for life threatening bleeds are higher in this category.  They need careful arterial review when you're at the CT scanner for the STAB.

VERTICAL SHEAR INJURY

-This one doesn't need a ton of explanation.  This pattern can occur through the joints (similar to the AP injury) or the bones (like the LC injury).  In this case, we have a nice mix: Pubic symphysis up front, Right hemisacrum fracture in the back. 

Remember - if you see an anterior injury, put your eyes on the sacrum, SI joints and medial ilia for a litte extra time. 

Review this reference and put it in your memory banks for your HCMC Call blocks.  

https://radiopaedia.org/articles/young-and-burgess-classification-of-pelvic-ring-fractures?lang=us