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Disruptions of Pelvic Ring
Julia R. Crim, MD
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KEY FACTS

  • Imaging

    • Top Differential Diagnoses

      • Pathology

        • Clinical Issues

          TERMINOLOGY

          • Synonyms

            • Tile types B and C fractures
          • Definitions

            • Partially stable fracture: Posterior pelvic integrity partially maintained; rotationally unstable, vertically stable
            • Unstable fracture: Complete loss of posterior pelvic integrity; rotationally and vertically unstable
            • Osseous or ligamentous disruption of pelvic ring, usually both anterior and posterior portions
              • Occasionally just anterior ring disruption (APC I)

          IMAGING

          • Basic Principles of Pelvic Ring

            • General Features

              • Radiographic Findings

                • CT Findings

                  • Ultrasonographic Findings

                    • Angiographic Findings

                      • Other Modality Findings

                        • Imaging Recommendations

                          • MR Findings

                            DIFFERENTIAL DIAGNOSIS

                              PATHOLOGY

                              • General Features

                                • Staging, Grading, & Classification

                                  CLINICAL ISSUES

                                  • Presentation

                                    • Demographics

                                      • Natural History & Prognosis

                                        • Treatment

                                          DIAGNOSTIC CHECKLIST

                                          • Consider

                                            • Reporting Tips

                                              • Pitfall

                                                Selected References

                                                1. Khurana B et al: Pelvic ring fractures: what the orthopedic surgeon wants to know. Radiographics. 34(5):1317-33, 2014
                                                2. Abrassart S et al: Unstable pelvic ring injury with hemodynamic instability: What seems the best procedure choice and sequence in the initial management? Orthop Traumatol Surg Res. 99(2):175-82, 2013
                                                3. Gänsslen A et al: Pelvic ring injuries in children. Part I: Epidemiology and primary evaluation. A review of the literature. Acta Chir Orthop Traumatol Cech. 79(6):493-8, 2012
                                                4. Hou Z et al: Hemodynamically unstable pelvic fracture management by advanced trauma life support guidelines results in high mortality. Orthopedics. 35(3):e319-24, 2012
                                                5. Hornez E et al: Management of exsanguinating pelvic trauma: Do we still need the radiologist? J Visc Surg. 148(5):379-84, 2011
                                                6. Starks I et al: Is a fracture of the transverse process of L5 a predictor of pelvic fracture instability? J Bone Joint Surg Br. 93(7):967-9, 2011
                                                7. Manson T et al: Young-Burgess classification of pelvic ring fractures: does it predict mortality, transfusion requirements, and non-orthopaedic injuries? J Orthop Trauma. 24(10):603-9, 2010
                                                8. Papakostidis C et al: Pelvic ring injuries with haemodynamic instability: efficacy of pelvic packing, a systematic review. Injury. 40 Suppl 4:S53-61, 2009
                                                9. Verbeek D et al: Acute management of hemodynamically unstable pelvic trauma patients: time for a change? Multicenter review of recent practice. World J Surg. 32(8):1874-82, 2008
                                                10. Gardner MJ et al: Stabilization of unstable pelvic fractures with supraacetabular compression external fixation. J Orthop Trauma. 21(4):269-73, 2007
                                                11. Suzuki T et al: Long-term functional outcome after unstable pelvic ring fracture. J Trauma. 63(4):884-8, 2007
                                                12. Durkin A et al: Contemporary management of pelvic fractures. Am J Surg. 192(2):211-23, 2006
                                                13. Marx J et al: Rosen's Emergency Medicine: Concepts and Clinical Practice. Vol 1. 6th ed. St Louis: Mosby. 717-35, 2006
                                                14. Bucholz et al: Rockwood and Green's: Fractures In Adults. Vol 2. 6th ed. Philadelphia: Lippincott Williams & Wilkins. 1584-1664, 2005
                                                15. Park J et al: Imaging of pelvic trauma. Contemporary Diagnostic Radiology. 28(24):1-6, 2005
                                                16. Demetriades D et al: Pelvic fractures: epidemiology and predictors of associated abdominal injuries and outcomes. J Am Coll Surg. 195(1):1-10, 2002
                                                17. Coppola PT et al: Emergency department evaluation and treatment of pelvic fractures. Emerg Med Clin North Am. 18(1):1-27, v, 2000
                                                Related Anatomy
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                                                Related Differential Diagnoses
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                                                References
                                                Tables

                                                Tables

                                                KEY FACTS

                                                • Imaging

                                                  • Top Differential Diagnoses

                                                    • Pathology

                                                      • Clinical Issues

                                                        TERMINOLOGY

                                                        • Synonyms

                                                          • Tile types B and C fractures
                                                        • Definitions

                                                          • Partially stable fracture: Posterior pelvic integrity partially maintained; rotationally unstable, vertically stable
                                                          • Unstable fracture: Complete loss of posterior pelvic integrity; rotationally and vertically unstable
                                                          • Osseous or ligamentous disruption of pelvic ring, usually both anterior and posterior portions
                                                            • Occasionally just anterior ring disruption (APC I)

                                                        IMAGING

                                                        • Basic Principles of Pelvic Ring

                                                          • General Features

                                                            • Radiographic Findings

                                                              • CT Findings

                                                                • Ultrasonographic Findings

                                                                  • Angiographic Findings

                                                                    • Other Modality Findings

                                                                      • Imaging Recommendations

                                                                        • MR Findings

                                                                          DIFFERENTIAL DIAGNOSIS

                                                                            PATHOLOGY

                                                                            • General Features

                                                                              • Staging, Grading, & Classification

                                                                                CLINICAL ISSUES

                                                                                • Presentation

                                                                                  • Demographics

                                                                                    • Natural History & Prognosis

                                                                                      • Treatment

                                                                                        DIAGNOSTIC CHECKLIST

                                                                                        • Consider

                                                                                          • Reporting Tips

                                                                                            • Pitfall

                                                                                              Selected References

                                                                                              1. Khurana B et al: Pelvic ring fractures: what the orthopedic surgeon wants to know. Radiographics. 34(5):1317-33, 2014
                                                                                              2. Abrassart S et al: Unstable pelvic ring injury with hemodynamic instability: What seems the best procedure choice and sequence in the initial management? Orthop Traumatol Surg Res. 99(2):175-82, 2013
                                                                                              3. Gänsslen A et al: Pelvic ring injuries in children. Part I: Epidemiology and primary evaluation. A review of the literature. Acta Chir Orthop Traumatol Cech. 79(6):493-8, 2012
                                                                                              4. Hou Z et al: Hemodynamically unstable pelvic fracture management by advanced trauma life support guidelines results in high mortality. Orthopedics. 35(3):e319-24, 2012
                                                                                              5. Hornez E et al: Management of exsanguinating pelvic trauma: Do we still need the radiologist? J Visc Surg. 148(5):379-84, 2011
                                                                                              6. Starks I et al: Is a fracture of the transverse process of L5 a predictor of pelvic fracture instability? J Bone Joint Surg Br. 93(7):967-9, 2011
                                                                                              7. Manson T et al: Young-Burgess classification of pelvic ring fractures: does it predict mortality, transfusion requirements, and non-orthopaedic injuries? J Orthop Trauma. 24(10):603-9, 2010
                                                                                              8. Papakostidis C et al: Pelvic ring injuries with haemodynamic instability: efficacy of pelvic packing, a systematic review. Injury. 40 Suppl 4:S53-61, 2009
                                                                                              9. Verbeek D et al: Acute management of hemodynamically unstable pelvic trauma patients: time for a change? Multicenter review of recent practice. World J Surg. 32(8):1874-82, 2008
                                                                                              10. Gardner MJ et al: Stabilization of unstable pelvic fractures with supraacetabular compression external fixation. J Orthop Trauma. 21(4):269-73, 2007
                                                                                              11. Suzuki T et al: Long-term functional outcome after unstable pelvic ring fracture. J Trauma. 63(4):884-8, 2007
                                                                                              12. Durkin A et al: Contemporary management of pelvic fractures. Am J Surg. 192(2):211-23, 2006
                                                                                              13. Marx J et al: Rosen's Emergency Medicine: Concepts and Clinical Practice. Vol 1. 6th ed. St Louis: Mosby. 717-35, 2006
                                                                                              14. Bucholz et al: Rockwood and Green's: Fractures In Adults. Vol 2. 6th ed. Philadelphia: Lippincott Williams & Wilkins. 1584-1664, 2005
                                                                                              15. Park J et al: Imaging of pelvic trauma. Contemporary Diagnostic Radiology. 28(24):1-6, 2005
                                                                                              16. Demetriades D et al: Pelvic fractures: epidemiology and predictors of associated abdominal injuries and outcomes. J Am Coll Surg. 195(1):1-10, 2002
                                                                                              17. Coppola PT et al: Emergency department evaluation and treatment of pelvic fractures. Emerg Med Clin North Am. 18(1):1-27, v, 2000