However, all models that started to distract at the sacral fracture site showed an iliac wing fracture on the right side or displacement of the sacroiliac joint on the left side after biomechanical testing. The presence and management of such injuries in the bioarchaeological. Comminuted fractures of the iliac wing request pdf. Pelvic, trauma, management, guidelines, mechanic, injury, angiography.
Right iliac wing fracture duverney fracture radiology. Aovet north america course principles in equine fracture. Pain associated with fractures of the anterior pelvis and iliac wing is shortlived and does not significantly alter the patients activity level. The strong, curved edge of the ilium that forms the iliac crest gives strength to the structure of the pelvis. Given the force necessary to disrupt the iliac wing the internal iliac vasculature can sometimes be disrupted. Both infections responded to local management and antibiotics. Duverney fractures are a type of pelvic fracture most commonly occurring in the setting of a direct blow to the ilium, with a resultant isolated iliac wing fracture. Management and decision making in the treatment of polytrauma patients with head. Posterior ring iliac fracture displaced or nondisplaced. It was treated by open reduction and internal fixation with two screws. Posterior wall fractures may occur in isolation or in combination with posterior column or transverse fractures. Iliac wing fractures are observed in fractures involving the anterior column, anterior column with posterior hemitransverse or both column fractures. If the fracture plane is perpendicular to the iliac wing, stability may be increased using cancellous lag screws in addition to the plate.
Pediatric pelvic fractures are uncommon and are usually the result of a highenergy mechanism. The fracture involved the tensor fascia lata muscle and the external oblique abdominal muscle. Transverse sacral fracture dislocation with anterior displacement. Asis, iliac crest, ischial tuberosity associated injuries. The evaluation and treatment of these fractures are described in pelvic fractures. The iliac crest is the attachment site for abdominal wall musculature and quadratus lumborum fig 2.
Hypotension and shock can arise secondary to hemorrhage from the internal iliac arterial system. The management of sacral fractures remains a challenge for the spine surgeon. Afterwards, the patient and the fracture should be stabilised. Biomechanical comparison of posterior fixation using. It is a stable fracture and often heals well given the stability from the surrounding musculature. We report a case of a penetrating bicycle handlebar producing an open iliac wing fracture. The case of an avulsion fracture occurring in an 18 year old athlete after repeated running is presented. Saqib rehman, md, colin slemenda, bs, christopher kestner, md, and siddharth joglekar, md.
The ct scan revealed that the patient had an acute occlusion of his left iliac artery, as well as a large left iliac wing fracture with a massive associated hematoma. Pelvic fractures can cause acute hindlimb lameness and occur predominantly in fillies while racing or training see chapter 49. After the medical management is finished the rehabilitation can start. Iliac fractures iliac fractures are fractures of the pelvic bone. During the primary survey, patients with pelvic ring fractures undergo decision making for day. Jul 01, 2003 stress fracture of the iliac bone in a young female runner. Only 10 sustained a fracture limited to the iliac wing, all after highenergy trauma. Aug 17, 2015 highimpact, unstable pelvic fractures.
Throughout the years, numerous classification systems and fixation techniques have been developed. Safe surgical technique for associated acetabular fractures. The aim of this study was to describe the characteristics of iiwf in geriatric patients, and to present a case series of iiwf in geriatric patients who underwent our minimally invasive screw fixation technique named iliac pillar screw fixation. Comminuted iliac fractures are uncommon and difficult to treat. Posterior hip fracturedislocation causes intraarticular fracture of the acetabulum and an unstable hip. Note the comminuted fracture with impaction of the anterior wall fig. Open iliac wing fracture caused by penetrating injury from. There were no complications associated with the degloving injuries. Because of the complex anatomy of the pelvis, a ct scan is commonly ordered for acetabular fractures. It has a wide, flat shape, and helps to protect the delicate abdominal organs. There was pubic diastasis, as well as a left superior rami fracture with a modest associated hematoma.
Major pelvic fractures present rapidly due to the circumstances of the trauma and the patients clinical condition. Some of this morbidity is attributable to the analgesia provided in the hospital. The fracture is named after the french surgeon joseph guichard duverney who described the injury in his book maladies des os which was published posthumously in 1751. Iliac wing fracture following graft harvesting from the anterior iliac crest 115 figure 1 anteroposterior view of the right hip shows a fracture of the anterior iliac wing starting at the level of the donor site. Determining pelvic ring stability after a pelvic fracture is important, because stable pelvic fractures are usually managed successfully with. The fracture may involve only the posterior acetabular wall or the fracture can extend upwards into the superior acetabular dome when it requires meticulous management. May 10, 2016 iliac wing fractures are observed in fractures involving the anterior column, anterior column with posterior hemitransverse or both column fractures. This article focuses on pelvic fractures that are caused by a highenergy event, such as a car collision. Lecture abstract manual aovet north america course principles in equine fracture management april 710, 2016 hilton columbus at easton hotel. Radiographic evaluation and classification of pelvic ring. Fractures of the iliac wing can also perforate the bowel and result in sepsis. Diagnosis and management of sacral spine fractures this information is current as of april 9.
Motor vehicle accidents account for 50% to 60% of traumatic pelvic fractures old age due to low bone mass and propensity of falling athletic injury involving avulsion fractures of the superior or inferior iliac spines or apophyseal avulsion fractures of the iliac wing or ischial tuberosity. Lateral directed force with fractures through iliac wing, sacral ala or foramina open book with anterior displacement 2. From 1993 to 2000 at the three new york racing association tracks, a diagnosis of pelvic fracture was made in 20 horses, 17 of which were. Six patients had an oblique fracture through the wing of the ilium which was bilateral in one case and nine a supraacetabular fracture, with in one case a superomedial extension into the iliac wing. Although several sacral fracture classification systems have been proposed, 19 21 none was widely adopted until 1988, when denis et al. Serious and potentially lifethreatening associated abdominal, vascular andor neurological injuries should be. It mostly occurs among young patients with a history of a seatbelt injury.
Diagnosis and management of pelvic fractures eric j. We report a case of 16yearold male competitive sprinter, who had an avulsion of a part of the iliac crest and the anteriorsuperior iliac spine during a competition. The last in this subgroup was the avulsion fracture type, which occurred at the insertion sites of the sacrotuberous and sacrospinous ligaments. Osteosynthesis in sacral fracture and lumbosacral dislocation. Repetitive posterior iliac crest autograft harvest. Stress fracture of the iliac bone in a young female runner. They typically respond well to nonoperative treatment, although the. Internal fixation of sacroiliac joint via posterior approach. Acetabulum fractures, pelvis fracture, emergency management. The juxtaarticular fracture type was similar to the lateral mass fracture type, but the fracture fragment was displaced. April 2016 posterior fixation using spinal implant 99 n 0 200 400 600 800 1,000 1,200 1,400 1,600 1,800. Any fracture of the pelvis caused by significant trauma should raise suspicion of trauma elsewhere head, thorax, spine, etc. First of all, if necessary, resuscitation must be done.
No specific classification for iliac wing fractures. The purpose of this study is to further delineate the fractures, to present a management protocol, and to evaluate the results of. Iliac crest pain is associated with chronic low back pain. Currently, although fusion rates remain high, longterm complications, such as residual pain andor neurological deficits, persist for many patients. Associated acetabular fractures are challenging injuries to manage.
Comminuted iliac fractures occur in two distinct patterns and are associated with numerous local injuries that complicate management. Iliac wing fracture following graft harvesting from the. Management of acetabulum fractures trauma international. Jacqueline callear, ku shah john radcliffe hospital, oxford abstract despite recent national advances in the care for the hip fracture patient, significant morbidity and mortality persists. Movement of the hemipelvis as manual traction is applied to the lower. Iliac stress fractures are uncommon and are usually insufficiency fractures related to osteoporosis. Another patient with an open fracture developed a deep wound infection. A number of reports have stressed the dichotomy between the benign external appearance and the potential severity of the intraabdominal injury after a bicycle handlebar injury. Avulsion fracture of the iliac crest is an uncommon pathology.
An isolated iliac wing fracture is a stable benign injury and can be managed conservatively. The cleaving fracture type began at the sacral notch and exited near the coccyx. Simple fracture patterns without associated pelvic ring instability are managed with nonoperative measures. An isolated iliac wing stress fracture in a marathon runner. Iliac wing fractures are caused by forces applied directly to the iliac wing. Bilateral symmetric fracture of the iliac bone is an extremely uncommon clinical entity that is not yet classified in the current classification systems of pelvic fractures. Pelvic fractures are mainly divided into unstable fractures resulting in pelvic ring deformity, and stable fractures, which include pubic ramus, iliac wing and avulsion fractures16. Neurologic disorder is frequently associated, and nerve release may be required, with reduction and stabilization of the fracture. The basic principles of emergency management, airway, breathing and circulation hold true for pelviacetabular fractures too. In the evaluation of the five most common acetabular fractures, assessment of the obturator ring, followed by the iliopectineal and ilioischial lines and iliac wing, for fracture allows accurate classification. Biomechanical comparison of posterior fixation using spinal. Surgical approaches of the pelvis roop bhushan kalia 1, alok chandra agrawal 2.
Morbidity associated with isolated iliac wing fractures. Unlike the anterior hemipelvis and iliac wing, fractures in the weighttransmitting. They are caused by direct trauma to the iliac wing, and are generally stable fractures as they do not disrupt the weight bearing pelvic ring the fracture is named after the french surgeon joseph guichard duverney who described the injury in his book maladies des os which was published posthumously in. Operative versus conservative treatment of apophyseal. This first article in the journals safe surgical technique section presents the standard. Transverse sacral fracturedislocation with anterior. Most pelvic fractures are stable and occur with a lowenergy mechanism of injury.
The stabilisation of pelvic fractures has historically been treated nonoperatively. Pelvic fractures carry a significant risk of uncontrolled pelvic bleeding and exsanguination from pelvic fractures is a. Learn more about possible causes of iliac crest pain and the types of exercises used to treat it. Only 2 previous case reports of iliac stress fractures in runners that extended into the sacroiliac joint, and 1 previous case of an isolated iliac wing stress fracture not involving the sacroiliac joint were found in the english language literature.
Introduction isolated fractures of the iliac wing that do not involve the weight bearing axis of the pelvis, also known as duverney fractures, are mechanically stable fractures because the pelvic ring remains intact. Pdf diagnosis and management of sacroiliac joint injuries. Brodke, mitchel harris, jens chapman, thomas schildhauer, m. Management of these injuries remains controversial. The complex surgical approaches and the technical difficulty in achieving anatomical reduction imply that the learning curve to achieve highquality care of patients with such challenging injuries is extremely steep.
Posterior acetabular arc angle of unstable posterior hip. Level one trauma center at harborview medical center. Your doctor and nurses will work to reduce your pain, which can. Fractures of the iliac wing are known to occur, 1, 810 but the majority are stable and surgical treatment has only been described in one case. Request pdf comminuted fractures of the iliac wing comminuted. Duverney fractures are isolated pelvic fractures involving only the iliac wing. Thus, a high index of suspicion must be maintained when evaluating a. Zone i alar zone fractures remain lateral to the neuroforamina. Internal fixation of sacroiliac joint via posterior approach in management of posterior pelvic injuries j ortho bone disord internal fixation of sacroiliac joint via posterior approach in management of posterior pelvic injuries tarek a and osama a orthopedic department, tanta university school of medicine, egypt. Ct is helpful in understanding the va rious fracture patterns. As pelvic fractures may be closed the degree of blood loss may not be initially clear. Iliac wing fractures orthopaedicsone articles orthopaedicsone. Surgical approaches of the pelvis kalia rb, agrawal ac j. Emergency reduction requires a stable hip and a concentric and smooth articular surface.
It is regarded as a stable injury but may be operated on in the event of severe. A case report 65 sacral fracture, 96% to 100% of patients had some neurological deficit 1,3, mainly in the form of bowel and bladder dysfunction and saddle anaesthesia, similar to what we found in this patient. Comminuted iliac fractures occur in two distinct patterns and are associated with numerous local injuries that complicate. Lateral directed force with fractures through iliac wing, sacral ala or foramina. They are caused by direct trauma to the iliac wing, and are generally stable fractures as they do not disrupt the weight bearing pelvic ring. Your doctor and nurses will work to reduce your pain, which can help you recover from surgery faster. Pelvic fractures fractures of the pelvis account for less than 5% of all skeletal injuries, but it is important because it associated with. Fracture of the iliac wing is also known as the duverney fracture. Avulsion fractures of the pelvic apophyses typically occur in adolescent athletes due to a sudden strong muscle contraction while growth plates are still open. The traumatism occurred during the period of acceleration phase out of the. Theodore hill, in diagnosis and management of lameness in the horse second edition, 2011. Sacral fracture and lumbosacral hinge trauma are rare but serious lesions. Pelvic instability secondary to removal of the posterior sacroiliac ligaments during the harvest of bone graft has been described and in some cases, operative intervention was required 12.
Medical management of pelvic fractures consists of many parts. Using the classification established for osteoporotic iliac wing fractures, our case was a type 3 supraacetabular. It usually occurs in teenagers during sport activities, more common in boys. Introduction isolated fractures of the iliac wing that do not involve the weight. Management of gunshot pelvic fractures with bowel injury. Xrays of acetabular fractures are taken from a number of different angles to show the pattern of the fracture and how out of place the bones are displacement. Avulsion fracture of the anterior superior iliac spine. For example, the bone can break straight across the socket or shatter into many pieces.
One hundred twenty patients had major pelvic trauma. Request pdf morbidity associated with isolated iliac wing fractures iliac wing. The patient returned to full training, including long distance running, only four weeks after the operation. The iliacus muscle overlies the inner iliac table, and the femoral nerve lies medial to it in the groove between the iliacus and the psoas muscle.
Chapter 51 diagnosis and management of sacroiliac joint injuries 585 the dorsal portion of the dorsal sacroiliac ligament at the insertion on the tuber sacrale was reported. The fracture line crosses the acetabulum, through the posterior injured sciatic notch and anterior columns and ends in the iliac wing. The purpose of this study is to further delineate the fractures, to present a management protocol, and to. Minimally invasive surgical treatment using iliac pillar. Internal fixation of sacroiliac joint via posterior approach in management of posterior pelvic injuries. The purpose of this study is to further delineate the fractures, to present a management protocol, and to evaluate the results of treatment. Management requires knowing the fracture lines and reduction maneuvers and the fixation techniques that may need to be associated. However there are certain practical tips and principles that will help in getting better results in these situations. Using the classification established for osteoporotic iliac wing fractures. Morbidity associated with isolated iliac wing fractures request pdf. Surgical management of chapter 20 metastatic bone disease. The acute management of pelvic ring injuries orthopaedic.
Generally described as specific subtypes of more common classification systems. Because the pelvis is in proximity to major blood vessels and organs, this type of fracture may cause extensive bleeding and other injuries that require urgent treatment. This is an enhanced pdf from the journal of bone and joint surgery j bone joint surg am. There have been no prior case series of isolated iliac wing fracture iiwf due to lowenergy trauma in geriatric patients in the literature. A right iliac wing fracture was located near the sacroiliac joint. When the acetabulum is fractured, the femoral head may no longer fit firmly into the socket, and the cartilage surface of both bones may be damaged.
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