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Updated: Jun 28 2025

Pelvic Ring Fractures

Images
  • Summary
  • Etiology
  • Anatomy
  • Classification
  • Physical Exam
  • Imaging
    • Radiographs
      • recommended views
        • AP
          • part of initial ATLS evaluation
          • look for asymmetry, rotation or displacement of each hemipelvis
          • evidence of anterior ring injury needs further imaging
        • inlet
          • xray beam angled 40° caudad (may be as little as 25 degrees)
            • adequate image when S1 overlaps S2 body (i.e. perpendicular to S1 endplate)
          • ideal for visualizing
            • anterior or posterior translation of the hemipelvis
            • internal or external rotation of the hemipelvis
            • widening of the SI joint
            • sacral ala impaction
        • outlet
          • xray beam angled ~40° cephalad (may be as much as 60 degrees)
            • adequate image when pubic symphysis overlies S2 body
          • ideal for visualizing
            • vertical translation of the hemipelvis
            • flexion/extension of the hemipelvis
            • disruption of sacral foramina and location of sacral fractures
        • Single-leg stance AP pelvis ("flamingo views")
          • Patient alternates with right and left foot up while AP pelvis is obtained
            • Used in evaluation of suspected chronic pelvic ring instability
            • Examiner measures vertical translation of the pubic bones
            • Serves as a means of assessing pathologic motion at the SI joint
      • findings
        • radiographic signs of instability
          • > 5 mm displacement of posterior sacroiliac complex
          • presence of posterior sacral fracture gap
          • avulsion fractures (ischial spine, ischial tuberosity, sacrum, transverse process of 5th lumbar vertebrae)
    • CT
      • routine part of pelvic ring injury evaluation
      • better characterization of posterior ring injuries
      • helps define comminution and fragment rotation
      • visualize position of fracture lines relative to sacral foramina
      • radiographic signs of sacral dysmorphism:
        • anterior up-sloping upper sacral ala
        • irregular, non-circular, sacral nerve root tunnels
        • residual S1 disk
        • tongue-and-groove SI joint
  • Studies
  • Initial Management & Resusitation
  • Definitive Treatment
  • Techniques
  • Complications
  • Prognosis
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Question Session⎪Pelvic Ring Fractures
  • Trauma
  • - Pelvic Ring Fractures
37:2 min
1/14/2020
711 plays
5.0
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(4)
Trauma | Pelvic Ring Fractures
  • Trauma
  • - Pelvic Ring Fractures
32:43 min
1/14/2020
5899 plays
5.0
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(57)
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