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Hips - Dr. Bates

10/31/2013

0 Comments

 
PictureOuch!!
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

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  • RESIDENCY
    • About CMC
    • Curriculum
    • Benefits
    • Explore Charlotte
    • Official Site
  • FELLOWSHIP
    • Fellowships at CMC
    • EMS
    • Global EM
    • Pediatric EM
    • Toxicology >
      • Tox Faculty
      • Tox Application
  • PEOPLE
    • Program Leadership
    • PGY-3
    • PGY-2
    • PGY-1
    • Alumni
  • STUDENTS/APPLICANTS
    • Medical Students at CMC
    • EM Acting Internship
    • Healthcare Disparities Externship
    • Resident Mentorship
  • #FOAMed
    • EM GuideWire
    • CMC Imaging Mastery
    • Pediatric EM Morsels
    • Blogs, etc. >
      • CMC ECG Masters
      • Core Concepts
      • Cardiology Blog
      • Dr. Patel's Coding Blog
      • Global Health Blog
      • Ortho Blog
      • Pediatric Emergency Medicine
      • Tox Blog
  • Chiefs Corner
    • Top 20
    • Current Chiefs
    • Schedules >
      • Conference/Flashpoint
      • Block Schedule
      • ED Shift Schedule
      • AEC Moonlighting
      • Journal Club/OBP/Audits Schedule
      • Simulation
    • Resources >
      • Fox Reference Library
      • FlashPoint
      • Airway Lecture
      • Student Resources
      • PGY - 1
      • PGY - 2
      • PGY - 3
      • Simulation Reading
      • Resident Wellness
      • Resident Research
      • Resume Builder
    • Individualized Interactive Instruction