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.

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