Pelvic Fractures

17 Pelvic Fractures



Anatomy of the Pelvic Skeleton



image

Bony Pelvis and Ligaments



Coxal Bones (Os Coxae; 2)



Ilium: Parts and Landmarks



• Crest, ala (wing), fossa (of false pelvis), articular surfaces

• Posterior superior iliac spine (at posterior part of articular surface)

• Iliac tuberosity: posterior sacroiliac ligament insertion

• Anterior superior iliac spine (ASIS): sartorius, inguinal ligament insertions

• Anterior inferior iliac spine (AIIS): rectus femoris, tensor fasciae latae, iliofemoral ligament (hip joint capsule) insertions

• Greater sciatic notch: sciatic nerve, piriformis muscle, pudendal neurovascular bundle exit here

• Ilium often used for cortical and cancellous bone grafts


Ischium: Parts and Landmarks



• Ischial spine: sacrospinous (SS) ligament insertion

• Body

• Ischial tuberosity: sacrotuberous (ST) ligament, hamstring insertions

• Ischial ramus: fuses with pubic ramus to form medial rim of obturator foramen


Pubis: Parts and Landmarks



• Tubercle: medial attachment of inguinal ligament (external oblique aponeurosis)

• Superior public ramus: pecten pubis (pectineal line), along inner superior ridge

• Symphysis: midline fibrous joint of superior pubic rami

• Inferior pubic ramus

• Arch: formed by inferior pubic and ischial rami

• Acetabulum formed by portions of all three bones
image Parts: articular surface, notch, limbus (margin)

image Should fuse by age ~20 years

• Arcuate line: medial ridge running from ilium (near superior sacroiliac joint) to pecten pubis

• Linea terminalis
image Bony upper border of the true pelvis, lower border of false pelvis

image Sacral promontory to iliopectineal line: arcuate line + pectineal line


Sacrum



• Parts and landmarks: ala, sacroiliac articular surfaces, lumbosacral articular (disc) surface, promontory, fused bodies (5), anterior and posterior foramina, coccyx (~4 segments)

• Sacral canal: continuation of vertebral canal with meninges and roots of spinal cord

• Posterior: median and lateral sacral crests, superior articular facet (to L5 inferior facet), sacral hiatus (end of sacral canal, ref. for caudal anesthesia)

• Posterior and anterior sacrococcygeal ligaments


Pelvic Joints



• Sacroiliac (SI)
image Synovial joints with minimal movement

image Posterior pelvis stability, weight-bearing

• Pubic symphysis: anterior pelvis

• Coxal
image Ilium, ischium, and pubis intersect in acetabular fossa.

image Typically fused by age 20 years


Pelvic Ligaments



• Sacroiliac
image Anterior and posterior (more extensive)

image Support SI joints

• Sacrotuberous; lower border of lesser sciatic foramen

• Sacrospinous: lower border of greater sciatic foramen, anterior to coccygeus fibers

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Aug 12, 2016 | Posted by in ANATOMY | Comments Off on Pelvic Fractures

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