By Marvin Tile
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Additional resources for Fractures of the Pelvis and Acetabulum
Lateral compression injuries cause visceral damage by direct bony penetration. The anterior rotation of the hemipelvis in a lateral compression injury may drive the bony spike of the pubic rami into the bladder or rupture it by increasing intravascular pressure. Posteriorly, the compression injury of the sacrum through the foramina may compress any of the sacral nerve roots. CONCLUSION FIGURE 4-14. In some instances, a lateral compressive force may rupture the posterior ligamentous structures, especially in younger patients.
In unstable fracture types (C), fixation only, of the posterior structures, may lead to redisplacement of the hemipelvis, because 40% of pelvic instability remains resulting in compromised outcomes (8). Therefore, these patients require adequate stable fixation both front and back to allow mobilization safely (Fig. 4-9) (see Chapter 15). Division of a Ring Structure Because the pelvis behaves as a stable ring-like structure, it is theoretically not possible to break the pelvis in just one spot.
Grant describes the posterior sacroiliac interosseous ligament as the strongest ligament in the body. When one understands its function, the reason for this becomes obvious. The posterior sacroiliac ligamentous complex prevents posterior displacements of the pelvic ring on the sacrum, or from the alternative point of view, anterior displacements of the sacrum and axial skeleton on the pelvis. Although this 4: Pelvic Ring 33 posterior sacroiliac ligamentous complex acts as the primary stabilizer to the posterior pelvis, the caudally positioned sacrospinous and sacrotuberous ligaments as well as the pelvic floor augment stability (Figs.