Hips - Dr. Bates

Ouch!!

Key ligaments

• Anterior and Posterior SI ligaments - Think about them with or without fractures if SI joint widened

Key Arteries

• Superior and inferior gluteal
• Venous > arterial in common cause of blood loss
  

Fracture Classification - Young-Burgess

• Lateral Compression (LC) - Think about associated head injury and intrabdominal injuries:Three grades of severity with increasing internal rotation.

1. Lc1 - fracture of rami. 
2. LC 2 - iliac wing fracture plus rami fracture.
   
3. LC3 - external rotation of contralateral pelvis.

• Anterior Posterior Compression (APC) - More likely to bleed severely; external rotation of hemi pelvis around sacrum. Diastasis of pubic symphysis should be <2.5cm.

1. APC1 - pubic symphysis gap- lig stretched, not torn, less than 2.5 cm diastasis SI
2. AP2 - open book pelvis, anterior SI ligament rupture, pub symphysis widening
   
3. APC3 - complete separation of ilium from sacrum - need binder, require massive resusc. Apply to greater trochanter. Knotted sheet can cause pressure ulcers so should only be temporary.

• Vertical Shear
  

Pelvic ring injuries

• Severe injury
• Anatomy- ilium, ischium, pubis, symphysis less than 5 cm, SI
  

• Physical- leg rotation, instability, degloving, limb shortening, look for open injuries- look in vagina and perineum\
• Damaged visceral anatomy- bladder, urethra rectum
  

• Radiographs- signs of instability- si too wide, post frx gap, leg deformity

1. AP- high yield, for immediate mgt, coccyx directly over pubis
2. Inlet- anterior or posterior displacement of ilium/pub rami frx
3. Outlet- sacral frx, superioir displacement of hemipelvis
4. CT- posterior injury, visceral or vascular injury, Good for operative planning.
   
5. Judet- acetabulum frx
   

---