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    Facultatea de Medicina Generala Ortopedie-Traumatologie Anul IV

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    Kristal Ylli
    The document discusses acetabular fractures, including their classification, mechanisms of injury, clinical presentation, imaging, and treatment approaches. It describes Letournel's classification system for acetabular fractures, which is based on the integrity of the anterior and posterior columns. Fracture patterns are discussed in relation to the mechanisms of injury. Clinical examination findings and appropriate imaging are outlined. Treatment principles focus on stabilization, reduction of fracture displacement, and definitive surgical fixation to restore stability, mobility, and joint congruity.

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    Facultatea de Medicina Generala Ortopedie-Traumatologie Anul IV

    Uploaded by

    Kristal Ylli
    36 views53 pages
    The document discusses acetabular fractures, including their classification, mechanisms of injury, clinical presentation, imaging, and treatment approaches. It describes Letournel's classification system for acetabular fractures, which is based on the integrity of the anterior and posterior columns. Fracture patterns are discussed in relation to the mechanisms of injury. Clinical examination findings and appropriate imaging are outlined. Treatment principles focus on stabilization, reduction of fracture displacement, and definitive surgical fixation to restore stability, mobility, and joint congruity.

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    The document discusses acetabular fractures, including their classification, mechanisms of injury, clinical presentation, imaging, and treatment approaches. It describes Letournel's classification system for acetabular fractures, which is based on the integrity of the anterior and posterior columns. Fracture patterns are discussed in relation to the mechanisms of injury. Clinical examination findings and appropriate imaging are outlined. Treatment principles focus on stabilization, reduction of fracture displacement, and definitive surgical fixation to restore stability, mobility, and joint congruity.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    36 views53 pages

    Facultatea de Medicina Generala Ortopedie-Traumatologie Anul IV

    Uploaded by

    Kristal Ylli
    The document discusses acetabular fractures, including their classification, mechanisms of injury, clinical presentation, imaging, and treatment approaches. It describes Letournel's classification system for acetabular fractures, which is based on the integrity of the anterior and posterior columns. Fracture patterns are discussed in relation to the mechanisms of injury. Clinical examination findings and appropriate imaging are outlined. Treatment principles focus on stabilization, reduction of fracture displacement, and definitive surgical fixation to restore stability, mobility, and joint congruity.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
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    of 53

    Facultatea de Medicina Generala

    Ortopedie-traumatologie
    Anul IV

    Prof. Dr. Olivera Lupescu


    Inverted “Y” two column concept –
    Judet, Letournel (1966)
    Anterior
    column

    Post
    column

    1. Judet R, Judet J, Letournel E. Fractures of the acetabulum:


    60 deg classification and surgical approaches for open reduction.
    J Bone Joint Surg Am 1964;46:1615–1645
    Downwards 2. Letournel E, Judet R. Fractures of the acetabulum.
    Berlin, Germany: Springer-Verlag, 1981
    Anteriorly 3. Letournel E. Acetabular fractures: classification
    and management. Clin Orthop 1980;151:81–106
    Inward
    Stabilitatea
    Mobilitatea
    Congruenta
     Immediate- n. sciatic; fractura-luxatie

     Precoce si secundare- trombo-embolice I


    septice

     Tardive- coxartroza !!!


    Oase+ aparat capsulo-ligamentar
    Stabilitate redusa
    -60 %- structurile posterioare
    -40 %- structurile anterioare

    Vascularizatie bogata
    Sangerarea in fracturile de
    bazin
    -vasculara-
    - 90 % venoasa
    - 10% arteriala
    -fragmentele osoase
     Radiografia AP
     Inlet & outlet view
     Reconstructie 3D- obligatorie
     Localizarea fracturilor
     Gradul de deplasare
     Clasificarea fracturilor functie
    de stabilitate si mecanismul
    de producere
    ◦ Functie de mecanism- LC/ APC/
    Mixt
    ◦ Functie de arcul posterior
     Intact- stabile (A)
     Mica deplasare- partial stabile
    (B)
     Deplasare – instabile ( C)
    Arcul
    posterior

    Arcul
    anterior

    Tile M. Acute pelvic fractures: I. Causation and classification. J Am Acad Orthop Surg. 1996;4(3):143-51.
    Clasificarea Tile- Integritatea
    arcului posterior
    Partially
    Stable
    Clasificarea
    B Tile

    Unstable C
    Stable

    A
    Partial SI joint
    disruption

    AP compression

    Anterior SI
    ligaments-
    disrupted

    External
    rotation

    AP compression
    Symphisis disruption
    Tile M. Acute pelvic fractures: I. Causation and classification. J Am Acad Orthop Surg. 1996;4(3):143-51.
    Posterior SI ligaments disrupted

    Anterior sacral
    compression

    Partial
    Rami fx stability

    Sacral
    compression

    Lateral compression
    (implosion) Internal
    rotation of the pelvis Pelvic floor
    intact
    Tile M. Acute pelvic fractures: I. Causation and classification. J Am Acad Orthop Surg. 1996;4(3):143-51.
    vertical
    post

    Shearing
    (translational)
    forces= vertical /
    posterior
    Tile M. Acute pelvic fractures: I. Causation and classification. J Am Acad Orthop Surg. 1996;4(3):143-51.
    Antero_Posterior Compression
    Lateral Compression LC
    APC

    Vertical Shear VS
     Anamneza- energie inalta,
    impact anterior/lateral
     Examenul clinic
    ◦ Pelvis- creste iliace
    ◦ Extremitati inferioare :
    scurtare, instabilitate External rotation
    rotationala , pozitii vicioase Shortening
    ◦ Manevrele de compresiune
    ◦ Hematurie/ sangerare la meat
    ◦ Rect si vagin
    ◦ Examinarea vasculara
    periferica
    ◦ Examinare neurologica
     Reducerea volumului pelvin
     Hemostaza-oprirea sangerarii la

    nivelul oaselor pelvisului si


    vaselor
     Prevenirea leziunilor suplimentare

    in urma miscarii pelvisului


     Diminuarea durerii
    Haemodinamica
    Fractura
    Stabil Instabil

    Stabila

    Instabila
    Stabilizarea temporara
    Binder C-clamp ExFix

    Orthopedic Internal surgical stabilisation ( ETC)


    Definitive
    Save the life!!!! Restore the life !!!!!!!
     Play well with others (anest, general
    surgery, urology, interventional  Play well with others (anest)
    radiology, neurosurgery)

     Understand the fracture pattern

     Do something (sheet, binder, ex fix,


     Understand the fracture pattern
    c-clamp)
     Combine knowledge of the
     Combine knowledge of the fracture, fracture, the patients condition,
    the patients condition, and the and the physical exam to
    physical exam to decide on the next perform
    step
     Definitive proper stabilisation
    Se aplica in zona trohanteriana, nu la nivelul crestelor
    iliace !!
    La nivelul crestelor iliace
    Supra-acetabular
    ACCIDENT RUTIER. POLITRAUMATISM.
    TCCGRAV.GCS:4.HEMORAGIE SUBARAHNOIDIANĂ.
    CONTUZIE PULMONARA ; FRACTURI COSTALE MULTIPLE
    FRACTURĂ COMPLEXĂ DE BAZIN. DISJUNCŢIE SACRO ILIACĂ
    STANGA. FRACTURĂ COMINUTIVĂ DE SACRU. FRACTURĂ RAM ILIO-
    ISCHIO-PUBIAN STÂNG. FRACTURĂ RAM ILIO-PUBIAN DREPT”
    Aspect comparativ al
    articulatiilor sacro-iliace

    Pozitionarea fiselor

    Aspect pre si post-


    reductional
    Contraindicatii
    C-clamp -fracturile aripii iliace
    -fracturile care interesează zona de insertie a C-
    Indicat in stabilizarea clamp-ului,
    leziunilor posterioare -fracturile cominutive ale sacrului, când contenţia
    posterioară poate produce telescoparea
    fragmentelor fracturare
     Damage control
    Politraumatism. Traumatism toraco-abdominal grav
    Fractura stabila de bazin ( disjunctie sacro-iliaca Binder- pozitia initiala
    dreapta si aripa iliaca dreapta) . Plaga contuza
    perineala
    Instabilitate hemodinamica persistenta-pelvic
    packing
    Binder- pozitia corecta
    ◦ Traumatism abdominal
    cu : ruptura de splina,
    ruptura de mezenter,
    intestine- rezectie
    partial, splenectomie
    ◦ Fractura instabila de
    bazin- fractura de sacru
    si disjunctie sacro-iliaca
    stg , fractura arc anterior
    cu deplasare
    BORDERLINE
    Damage Control- Fixator
    Extern ( initial)

    Reducerea deplasarii posterioare


     Timpul II ( dupa
    stabilizarea
    pacientei)-
    reducerea pe abord
    ilio-inghinal
    +osteosinteza cu
    placa si suruburi-
    rezultat clinic si
    radiologic foarte
    bun
    50
    51
    Fractura

    Stabilitate
    Hemodinamica
    THINK !!! TEAM WORK

    53
    Primum Non Nocere

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