![]() ![]() The exposure offered by the Kocher-Langenbeck approach is limited cranially and anteriorly by the superior gluteal neurovascular pedicle. The starting point for the anterior column screw applied through the Kocher-Langenbeck exposure (1) is different than that applied through the extended iliofemoral (2). It is aimed anteriorly towards the root of the superior pubic ramus. The anterior screw is placed obliquely from above the greater sciatic notch across the fracture. A washer is not usually necessary and allows the screw to sit flush with the bone such that subsequent plate fixation is not compromised. Insert a screw of the appropriate length. Use an oscillating drill to protect the soft tissues. Continue with the 2.5 mm (3.2 mm) drill bit, aimed towards the anterior column. It offers less robust fixation, but is more easily inserted.Ĭreate a gliding hole with a 3.5 mm (4.5 mm) drill bit, depending upon chosen screw size. The trajectory of the screw will be from the postero-superior aspect of the acetabulum towards the antero-inferior aspect, but will be shorter than a screw placed along the entire anterior column. Most transverse fractures are oblique, exiting higher on the inner table of the pelvis than on the outer table such that a lag screw inserted above the fracture line will compress the fracture along its length.Ī 3.5 mm (or 4.5 mm) cortical screw will be used. Lag screw fixation of the transverse fracture The earlier the closure, the greater the eventual deformity.After obtaining anatomical reduction of the transverse fracture, there are two options for initial fixation. Leads to premature triradiate cartilage closure. May detect narrowing of triradiate space. type IV pelvic ring with instability and > 2 cm pelvic ring displacementīlow to pubis/ischial ramus/proximal femur leads to injury at interface of 2 superior arms of triradiate cartilage and metaphyses of ilium.Ī triangular medial metaphyseal fragment (Thurston-Holland fragment) is often seen in SH II injuries.ĭifficult to see on initial radiographs.type III pelvic ring with displaced acetabular fractures > 2mm.type II iliac wing fractures with > 2-3 cm displacement.obturator oblique = open obturator foramen.iliac oblique = visualization of iliac wing.obturator oblique = posterior wall + anterior column.iliac oblique = anterior wall + posterior column.obturator oblique = semi-lateral 45° on contralateral side.iliac oblique = semi-lateral 45° on ipsilateral side.superimposition of pubic symphysis + S2 body.vertical displacement + flexion/extension of hemipelvis.til 20-35° cephalad if male, 30-45° cephalad if female.equal distance between greater trochanters + sacrum.measurement of horizontal/bi-ischial diameter.assess relationship of femoral head + acetabulum.pelvis tilted anteriorly 45° + hips abducted.superimposition of posterior ischium/ilium.no superimposition of femurs + pubic arch.if lesser trochanters are visible, they should be of symmetrical size and shape.too much external rotation of leg leads to increased visualization of lesser trochanter.symmetrical greater trochanters + obturator foramen.coccyx located 2cm above pubic symphysis.posterior ¼ = lower ½ of sciatic buttress to roof of greater sciatic notch.anterior ¾ = pelvic brim, pubic symphysis to ilioischial line. ![]() iliopectineal line (6) = anterior column.always superimposed on teardrop = disruption 2/2 rotation vs.pelvic brim + quadrilateral surface + posterior obturator foramen + ischiopubic ramus.ilioischial line (5) = posterior column.internal + external limbs = not in same coronal plane but usually parallel + forms U.internal/medial limb = outer wall of obturator canal + quadrilateral surface.lower border = ischiopubic/acetabular notch + superior obturator foramen.external/lateral limb = inferior anterior acetabular wall + outer cotyloid fossa.teardrop (4) = anterior/posterior column.acetabular roof = superior weight-bearing portion.sourcil (3) = anterior/posterior column.inferior margin of superior pubic ramus.anterior rim (2) = anterior wall/column.posterior rim (1) = posterior wall/column.aim midway between ASIS + pubic symphysis.Myelodysplasia (myelomeningocele, spinal bifida)ĭysplasia Epiphysealis Hemimelica (Trevor's Disease) Obstetric Brachial Plexopathy (Erb's, Klumpke's Palsy)Īnterolateral Bowing & Congenital Pseudoarthrosis of TibiaĬerebral Palsy - Upper Extremity Disorders Proximal Tibia Metaphyseal FX - PediatricĬhronic Recurrent Multifocal Osteomyelitis (CRMO) Pediatric Ankle Trauma Radiographic Evaluationĭistal Humerus Physeal Separation - Pediatric Pediatric Knee Trauma Radiographic Evaluation Pediatric Hip Trauma Radiographic Evaluation Pediatric Pelvis Trauma Radiographic Evaluation
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