Fracture Repair of the Pelvis

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bones of the os coxae

-illium
-ischium
-acetabular bone
-pubis

pelvic fractures and concurrent injuries

Rsk of concurrent injury is very high due to the high energy of the
needed to cause the fracture.

pelvic fractures and concurrent thoracic injuries

There is a high change of thoracic trauma: pneumo- or hemothorax,
diaphragmatic hernia, pulmonary contusions

pelvic fractures and abdominal injuries

Be sure to examine for GI tract, urinary tract, or organ rupture and abdominal hernias.

pelvic fractures and other fractures

Be sure to examine the patient for other skull, spine, or long bone fractures.

patient evaluation and pelvic fractures

-triage and treat for shock first
-always do chest films to look for thoracic injury
-determine if the dog can walk on three legs to help rule out severe
spinal injury and additional orthopedic injury
-perform neurological exam and rectal exam
-re-evaluate frequently

factors that benefit the healing and stability of pelvic fractures

-surrounded by large muscle mass, making it and inherently stable
structure
-the large muscle mass provides good blood supply
-the ilium is largely cancellous bone, healing relatively quickly

indications for surgical fixation of the pelvis

-fracture along the weight bearing axis
-articular fracture of the acetabulum
-greater than 50% narrowed pelvic canal
-neurologic comprise of the sciatic or femoral nerves

fractures of the weight bearing axis

-ilial body fracture
-sacroiliac luxation
-acetabular fracture

clinical signs of pelvic canal narrowing

-constipation or obstipation
-dystocia
-urethral obstruction

free floating hip

An ilial body fracture combined with pubic and ischial fractures.

pelvic fractures that require surgical repair

-sacroiliac luxation
-ilial body fracture
-acetabular fracture

repair of a sacroiliac fracture

-a bone plate in the preferred method
-a screw can be placed into the the sacral body for added purchase
-repair of the ilium usually lines up the ischium and pubis as well

sacroiliac luxation

-craniodorsal displacement of the ilium relative to the sacrum, causing
a palpable laxity

complications of sacroiliac luxation

May cause sacral nerve damage

indications for conservative treatment of a sacroiliac luxation

-little or not contralateral injury
-minimal displacement
-small dog or cat
-minimal pain
-in the luxation is indirectly stabilized by repair of the other side

indications for surgical repair of a sacroiliac luxation

-severe displacement (greater than 50%) with laxity
-contralateral hindlimb fractures

benefits of surgical repair of a sacroiliac luxation

-decreases pain
-improves recovery
-earlier ambulation

surgical repair of a sacroiliac luxation

-a lag screw is placed across the ilium into the sacrum, engaging 60%
of the sacrum
-use as large a screw as possible

open approach to sacroiliac luxation

Dorsal approach, exposing the SI joint by bringing the ilium caudoventrally

indications for a FHO to treat an acetabular fracture

-highly comminuted fractures
-repair cannot be accomplished during surgery
-may be done after primary surgery if the animal develops arthritis

indications for conservative treatment of an acetabular fracture

-non-displaced
-very caudal fractures

surgical repair of an acetabular fracture

-a variety of different plates are used
-often require a trochanteritc osteotomy to elevate the gluteal
musculature and expose the dorsal acetabular rim
-visual inspection of the articular surface is essential to a good
outcome

fractures of the pelvis that do not require surgical treatment

-ilial wing fractures
-ischial fractures, as most are reduced when other fractures are
repaired
-pubic fractures

components of conservative therapy

-cage rest for 4 to 6 weeks
-analgesics
-controlled exercise using all four limbs
-recheck in 6 to 8 weeks

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