Curriculum and Recommendations for Study
Pelvis and Hip: John H. Harris, Jr. MD, DSc
Case Illustration Editor: Manickam Kumaravel, MD

Pelvis Fractures of isolated bones of the pelvis that do not involve the pelvic ring iliac wing (Duvrney) sacrum coccyx avulsion ant. sup. iliac crest apoph. - sartorius m ant. inf. iliac crest apoph. - rectus femoris m ischial tuberosity - hamstring ms lesser troch. apoph. (femur) - iliopsoas Pelvic ring disruption. Disruption, ie., fracture or diastasis at two or more sites of the anterior and posterior pelvic arcs. Mechanism of injury lateral compression anteroposterior compression discrete: straddle injury diffuse: open-book pelvic ring disruption vertical shear Types of pelvic ring disruption Malgaigne (ipsilateral) bucket - handle (contralateral) open - book other fracture patterns without eponym Insufficiency fractures anterior pelvic arch sacrum Stress fractures Acetabular fractures (Involve only one side of the pelvic ring. Occur concomitantly with PRD in approximately 12%.) posterior column (most common) rim anterior column both columns - above, or through, acetabulum but spare the lunate surface transverse ("T") "T" with ant. column extension "T" with post. column extension

Hip Dislocation Posterior or posterosuperior pure fracture-dislocation. Fracture involves posterior or posterosuperior acetabular rim Anterior (obturator) Central Fractures (usually associated with dislocation). Posterior or posterosuperior acetabular rim Anterior (Involve the acetabular "tear-drop") Central Proximal femur Slipped capital femoral epiphysis (SCFE) Salter-Harris physeal injuries Fractures Head - usually associated with hip dislocation Neck subcapital transcervical basicervical Trochanteric intertrochanteric 2 - part (proximal/distal fragments) 3 - part (prox./distal + 1 trochanter) 4 - part (prox./distal + each trochanter) subtrochanteric isolated fracture, greater trochanter Avascular necrosis Stage I - radiograph negative Stage II - inhomogeneity of femoral head Stage III - Progressive inhomogeneity; trabecular disruption; "crescent" sign; subcondral cortical disruption. Stage IV - fragmentation of head

Suggested Readings:

Berquist TH, Coventry MB. The Pelvis and Hip. (In) Imaging of Orthopedic Trauma, 2nd ed.

Berquist TH, ed. Raven Press, 1992. Hip: 260-269; Pelvis: 228-240; Acetabulum; 240-246; Proximal femur: 269-272; 285-289.

Pelvis, acetabulum and hips. (In) The Radiology of Emergency Medicine. Harris JH, Harris WH,(eds); Williams & Wilkins, Baltimore; 2000, pp 725-814.

Young JWR: Fractures of the pelvis. (In) Imaging in Trauma and Critical Care, Mirvis SE & Young JWR (eds); Williams & Wilkins; Baltimore, MD; 1992, pp 380-420

Daffner RH: Pelvic trauma. (In) Trauma Radiology, McCort JJ & Mindelzun RE (eds); Churchill Livingstone; New York; 1990, pp 339-380

(In) Radiology of Skeletal Trauma (2nd Ed), Rogers LF (ed); Churchill Livingstone, New York; 1992; Fractures of the acetabulum, pp 1051-1074

Routt ML: Pelvic Fractures. & Mayo KA: Hip Joint: Acetabular Fractures. (In) Orthopaedic Trauma Protocols, Hansen ST & Swiontkowski MF (eds); Raven Press, New York, 1993; pp 225-236 & 243-254.