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Functional Medicine Explained
Imaging & Diagnostics

Acute Pelvis & Hip Trauma Imaging Diagnosis Part I | El Paso, TX.

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Pelvic Fractures Can Be Stable & Unstable

  • Unstable Fx: a result of high energy trauma with >50% d/t MVA
  • 20% closed Fx and 50% of open Fx result in mortality
  • Mortality is associated with vascular and internal organs injuries
  • Vascular injury: 20% arterial 80% venous
  • Chronic morbidity/disability and prolonged pain
  • Unstable Fx are rarely seen in the outpatient setting and typically and present to the ED
  • Stable pelvic Fx are usually caused by muscles/tendons avulsions and more often seen in pediatric cases

 

 

Understanding Pelvic Anatomy Is The Key To Successful Imaging Dx

  • The bony pelvis is a continuous ring of bone held by strong ligaments
  • During significant impact, pelvic fractures may occur in more than one location because forces applied to one region of the ring will also correspond to injury on the other, usually the opposite side of the ring (above image)
  • Thus the majority of unstable pelvic Fx will typically demonstrate more than one break

 

 

  • Pelvic is seen as a ring of� bone connected by some of the strongest ligaments in the body
  • The pelvic ring comprises 2-semirings: anterior to the acetabulum and posterior to the acetabulum
  • The bony pelvis is in close proximity to major vessels carrying a greater chance of vascular injury

 

 

  • Anatomical Differences of The Female and Male Pelvis

 

 

Post-Traumatic Pelvic Views May Vary and Include:

  • Standard AP Pelvis (above images)
  • Judet views evaluating the acetabulo-pelvic region
  • Inlet/Outlet views helping with the symphysis and SIJ regions
  • Rad survey of the pelvis should include evaluation of the continuity of pelvic rings:
  • Inlet/outlet, obturator rings (above the first image)
  • Symphysis pubis and SIJ for diastasis and post-trauma separation (above the second image)
  • Lumbosacral spine and hips should also be carefully examined

 

 

  • Pelvic inlet (above top left) and Outlet (above bottom left)
  • Judet views: left and right posterior oblique views

 

 

Additional Survey:

  • Iliopectineal, ilioischial, Shenton and Sacral arcuate lines will help detection of sacral, acetabular and hip fracture/dislocations

 

 

Stable Pelvic Fractures aka Avulsion Injury

  • Appreciating anatomical sites of pelvic origin/insertion of different muscles will help Dx of pelvic avulsion Fx

 

 

  • Avulsion Fx of the AllS (origin of the direct head of Rectus femoris M)
  • Pelvic avulsions occur by sudden eccentric contraction especially during kicking or jumping
  • Imaging: x-radiography will suffice
  • Clinically: sudden snap or pop followed by local pain. Pt can weight bear
  • Care: non-operative with rest for 4-weeks. Non-union is rare. No major complications
  • DDx: key rad DDx feature is not to mistake an avulsion from an aggressive pediatric bone tumor-like osteosarcoma that may show some exuberant new bone formation d/t healing and bone callus

 

 

Related Post

Commonly Encountered Unstable Pelvic Fractures

  • Malgaigne Fx: d/t vertical shear injury to the ipsilateral pelvis
  • Rad Dx: ipsilateral superior and inferior pubic rami Fx (anterior ring) with ipsilateral SIJ separation/Fx of the sacrum and adjacent ilium (posterior ring). Symphysis pubis diastasis can be seen. An additional clue is an avulsion of L4 and/or L5 TP that often signifies serious pelvic injury
  • Clinically: marked leg shortening, shock, inability to weight bear.
  • Damage to Superior Gluteal Artery can occur
  • Imaging: x-radiography followed by CT scanning w/o and with IV contrast esp. if visceral injury present
  • Care: surgical in most cases d/t significant instability. ORIF. Hemostasis, Pelvic stabilization
  • Prognosis: depends on the complexity, rate of visceral complications and stability. 10% Superior glut artery bleed requiring rapid hemostasis

 

 

Open Book Pelvis (major instability)

  • Mechanism: AP compression of different force magnitude (picture depiction)
  • Rad Dx: diastasis of symphysis pubis with diastasis of SIJ with and w/o adjacent Fx of the ala
  • Imaging steps: x-radiographic, CT scanning with and w/o contrast for vascular injury, cystography for acute urinary bladder rupture
  • Immediate and delayed complications may occur: vascular injury, urethral/bladder injury

 

 

Straddle Injury: Unstable Fx

  • Mechanism: direct impact/collision
  • High risk of urinary bladder/urethral injury
  • Imaging: bilateral superior and inferior pubic rami Fx with or w/o diastasis and Fx of SIJ
  • CT with and w/o contrast for vascular injury
  • Cystourethrogram additionally evaluates a urogenital injury
  • Complications: urethral strictures, bleeding, bladder rupture
  • Note: Straddle Fx with right SIJ separation

 

Hip Fractures (Femoral Neck)

  • Common injury
  • Occurs in:
  • 1) Young adults due to high energy trauma
  • 2) Osteoporotic patients with low impact, trivial or no trauma (i.e., insufficiency Fx)
  • X-radiography is crucial to early Dx and prevention of complications which include:
  • Dx: intra-capsular vs. extra-capsular Fx
  • Ischemic osteonecrosis aka avascular necrosis (AVN) of the femoral head and rapid disabling DJD
  • Epidemiology: USA has some of the highest rates of OSP hip Fx worldwide. Highest healthcare cost Fx to treat overall
  • Women>men, Caucasians>African-Americans
  • 25-30% mortality within the 1st year. Mortality depends on co-morbidities and stat of activity prior Fx
  • Pathophys: the femoral neck is intra-capsular and transmits arterial flow to the head. The neck is uncovered by the periosteum and unable to develop a good callus. The neck transmits maximum tensile forces through the proximal femur and prone to Fx and non-union

Hip Strengthening

 

 

Acute Pelvis & Hip Trauma

Post Disclaimer & Professional Scope of Practice *

The information herein on "Acute Pelvis & Hip Trauma Imaging Diagnosis Part I | El Paso, TX." is not intended to replace a one-on-one relationship with a qualified health care professional, licensed physician, and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional.

Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system.

Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.*

Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.

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Blessings

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

Dr Alex Jimenez

Welcome-Bienvenido's to our blog. We focus on treating severe spinal disabilities and injuries. We also treat Sciatica, Neck and Back Pain, Whiplash, Headaches, Knee Injuries, Sports Injuries, Dizziness, Poor Sleep, Arthritis. We use advanced proven therapies focused on optimal mobility, health, fitness, and structural conditioning. We use Individualized Diet Plans, Specialized Chiropractic Techniques, Mobility-Agility Training, Adapted Cross-Fit Protocols, and the "PUSH System" to treat patients suffering from various injuries and health problems. If you would like to learn more about a Doctor of Chiropractic who uses advanced progressive techniques to facilitate complete physical health, please connect with me. We focus on simplicity to help restore mobility and recovery. I'd love to see you. Connect!

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