Open-Book Pelvic Fracture - Report Example

Open-book Pelvic Fracture Introduction The phrase pelvic fractures refer to the disruption of the bony framework found at the pelvis, including the coccyx, sacrum and hipbone. The diagnosis for these injuries is made, depending on the clinical features of the injury, history of injury and investigative studies using CT scans and X-ray imaging (Dimon, 2010, 49-50). Open book fractures are caused by the application of a heavy force at the pubis (groin) area. This type of injury is characterized by the separation of the right and the left halves of the pelvis, at the rear and the front: the opening at the front is usually bigger than that at the rear, making the area appear like an open book (Hancharenka, Tuzikov, Arkhipau & Kryvanos, 2009). This injury is common among the victims of motorcycle accidents. Depending on the severity of the injury, surgical reconstruction may be needed before the area is rehabilitated. This type of injury increases the risks of hemorrhage following vessel injury or infection, leading to high levels of mortality (Walker, 2011). This paper will explore open-book pelvic fractures, including the anatomy, pathogenesis, etiology, radiographic indications and demonstrations, imaging modalities for diagnosis, treatment and prognosis. Anatomy of Open book pelvic fracture The common type of open book fracture is that which results from an external rotational movement at the hip joint area or an anteposterior compressive injury of the pelvis, opens the pelvis like a book, due to the disruption of the symphysis pubis (Walker, 2011). The extensive anatomical examination of the injury shows a continuum of injury, similar to the case with other pelvic disruptions. The examination reveals that the initial force leads to the avulsion of the symphysis pubis, in some cases, with a bone shell or through the fibers in the area (AAOS, 2009, pp. 154). The continuation of the force leads to the tearing of the pelvic floor fascia and also the rapture of the anterior sacroiliac ligaments, either bilaterally or unilaterally. The posterior ligaments of the region are not affected, and that maintains vertical stability. Other forms of the anteroposterior compressive injury include the case where, instead of the disruption of the anterior ligaments, the ilium is the one that fractures. Anteriorly, instead of the fracturing of the symphysis avulsion, the pubic rami may fracture (AAOS, 2009, pp. 154). Radiographic image of an open book pelvic fracture (Trauma Pelvis) Source: (Smith, Ziran & Morgan, 2013). Etiology and Pathogenesis of open book fracture An open book fracture is caused by an anteroposterior compressive injury at the pelvis. The compression injury leads to the disruption of the symphisis pubis, which forces the pelvis to rip open, like a book. The fracturing of the pubis rami, instead of that of the symphisis pubis, may be vertical or lateral, which refers to the case where fracture of the pubic rami is horizontally oriented (Smith, Ziran & Morgan, 2013). The fracture of the pubis rami may be accompanied by the disruption of the sacrolial joint. This injury results from the absorption of high impact force at the pubis (groin), during events that subject the individual to intense forces, including those from a motorcycle accident. During the accident, or a fall, the heavy impact felt at the pubis makes the right and the left halves of the pelvis to separate from the front to the rear. The opening at the front is bigger than that at the back, which gives it the shape of an open book (Smith, Ziran & Morgan, 2013). The injury can also be caused by forces from a posterior or anterior inclination, like in the case of a car collision, which leads to the external rotation of the hemipelvis, to take the shape of an open book. The cause (etiology) of open book fractures is different from one group to another. Among the aged, this disruption of the bone structure results from falls, from higher grounds or from a standing position (Walker, 2011). However, among younger individuals, the fracture is caused by more intense forces, including the impact of a motor vehicle accident, motorcycle accident, or fall from a considerable height (Garcia, 2011, p. 118). Radiographic indications and demonstrations Garcia (2011) presents the graphical indications and imaging of different patient cases, some of whom have sustained open book pelvic fractures from the impact of motor vehicle collisions. Radiological image of an open book pelvic injury (Case 59) Source: (Garcia, 2011, p. 117). The radiological image is a demonstration of the injury of a patient involved in a motor vehicle crash. The radiographic imaging of the pelvis shows the orientation of a fracture. In the case of the previous image, the fracture is vertically oriented, and goes through the left hemisphere of the public bone Garcia, 2011). In the next image, the same injury is shown, but with visual demonstrations and directive aids to direct the viewer to the fractures and the dislocations that are evident from the radiological image. Radiological image of an open book pelvic injury (Image with visual illustrations) Source: (Garcia, 2011, p. 118). The white arrows show the marked offsets that are evident from the fracture injury. The black arrows are used to show the diastasis of the left hemisphere of the sacroiliac joint (Garcia, 2011, p. 118). Imaging modalities used to diagnose disease Prior to the initiation of obtaining imaging modalities, the ABCs of trauma should be performed, including the examination of blood on the external meatus, which indicates the presence of urethral injury. In such a case, an urethrogram needs to be secured prior to the setting of a Foley catheter (Clelment, 2007, p. 536). Flexible sigmoidoscopy or protoscopy helps to examine the presence of and the location of the lesion. In the case that a dissection of the vertebral artery is detected, the process demands the incorporation of an invasive angiogram or CT angiogram to check the patency of the vertebral artery. In the case of a ruptured AAA, the surgical exploration for repair is necessary (Clelment, 2007, p. 536). A CT scan is effective in diagnosing the cases showing the indications of an AAA (Clelment, 2007, p. 537). The lateral radiograph of the sacrum is the best imaging modality option, because the dysmorphic sacral alar scope is viewed as more acute when checked using a lateral view (AAOS, 2009). Treatment of open book fracture The stabilization of the case will be dependent on precision of the diagnosis of the configuration of the fracture. However, irrespective of the configuration, where the pelvic ring is not displaced, only symptomatic treatment is necessary (AAOS, 2009). In such a case, the patient can be mobilized in no time, and the injury ignored. In the case of avulsion fractures at the iliac crest, particularly among young active patients, the problem is treated by fixing the displacement using lag screws. The fractures of the iliac wing, where there is a wide displacement are addressed using standard procedures, but the consent of the patient is very important, because they can cause an iliac crest misalignment (AAOS, 2009). Prognosis of open book fracture The mortality rates of the patients suffering from this condition is between 10 and 16 percent, despite the fact that the primary cause for death is the trauma that affects other body organs, including the brain (Maheshwari, 2012). The deaths caused by the direct complications of open book fractures among other pelvic fractures, which include excessive bleeding are considerable low. Conclusion Open book pelvic fractures are among the most common pelvic injuries, which affect the bone framework located at the pelvis. This injury results from the external rotation of the hip joint area or the anteposterior compression of the pelvis. The injury is caused by different factors, including falls among the aged and traumatic impacts among the young. The lateral radiographic imaging of the sacrum is the best imaging modality for the injury. The treatment procedure for the condition depends on the type of injury and the mortality of patients is mainly caused by the traumatic impact felt by other body organs. References AAOS. (2009). Advanced assessment and Treatment of Trauma (1st Edition). Sudbury, MA: Jones & Bartlett Learning. Clelment, M. (2007). Blueprints Q and As for Step 3. Baltimore, MD. Lipincott Williams and Wilkins. Dimon, T. (2010). The body in motion: its evolution and design. Berkeley, CA: North Atlantic Books. Garcia, G. (ed.). (2011). Musculoskeletal Radiology. New York: Thieme Medical Publishers, Inc. Hancharenka, V., Tuzikov, A., Arkhipau, V., & Kryvanos, A. (2009). Preoperative planning of pelvic and lower limbs surgery by CT image processing. Pattern Recognition and Image Analysis, 19 (1), 109–113. Maheshwari, J. (2012). Essential Orthopedics. London: Jp Medical Pub Smith, W., Ziran, B., & Morgan, S. (eds.). (2013). Fractures of the Pelvis and Acetabulum. New York: Informa Healthcare USA, INC. Walker, J (2011). Pelvic fractures: classification and nursing management. Nursing standard, 26 (10), 49–57. Read More