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FRACTURILE DE
BAZIN
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ANATOMIE
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ANATOMIE
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BIOMECANICA
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VASCULARIZATIE
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INERVATIE
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MECANISM DE
PRODUCERE
- ENERGIE JOASA Fracturi izolate
aleoaselor
bazinului
- ENERGIE INALTA Fracturi ale
inelului pelvin
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ENERGIE JOASA
- Ram iliopubian sau/si ischiopubian.
- Avulsia de: spina iliaca anterosuperioara
spina iliaca anteroinferioaratuberozitate ischiatica.
- Izolata (transversala) de sacru.
- Aripa iliaca
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ENERGIE INALTA
- Autovehicule- impact anteroposterior
- impact lateral
- tablou de bord
- Motocicleta - impact in sezut
- impact in genunchi
- Pieton - impactul cu vehiculul- - frontal
- lateral
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ENERGIE INALTA
- Cadere de la inaltime
- in picioare
- pe o parte
- Mecanisme penetrante
- arme de foc
- arme albe
- Zdrobire
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CLASIFICARE
Istoric - Clasificare anatomicain functie de sediul leziunii
-Clasificare anatomopatologica
in functie de numarul de intreruperi
ale inelului pelvin.
- In functie de mecanismul de producere:compresiune anteroposterioara
compresiune laterala
forfecare verticala (axiala)
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Clasificarea TILE
TYPE A Stable
A1Fractures of the pelvis not involving the ring
A2Stable, minimally displaced fractures of the ring
TYPE B
Rotationally unstable, vertically stable B1Open book
B2Lateral compression: ipsilateral
B3Lateral compression: contralateral (bucket-handle)
TYPE C
Rotationally and vertically unstable
C1Rotationally and vertically unstable
C2Bilateral
C3Associated with an acetabular fracture
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INSTABILITATE ROTATIONALA
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INSTABILITATE VERTICALA
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EXAMENUL CLINIC
- Palparea crestelor iliace- SIAS Manevra de apropiere sau
departare ATENTIE!
Exacerbarea hemoragiei
- Tuseu vaginal sau/si rectal eventual
anoscopie.
Uretrografie
Examen neurologic
Examen vascular
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EXAMENUL RADIOLOGIC
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EXAMENUL RADIOLOGIC
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EXAMENUL RADIOLOGIC
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DIAGNOSTIC
TOMOGRAFIA COMPUTERIZATA
RECONSTRUCTIATRIDIMENSIONALA
RMN
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LEZIUNI ASOCIATE
Hemoragia
- Cea mai redutabila complicatie
- Sursa: focarul de fractura
- leziuni arteriale sau/sivenoase
- locale
- leziunmi de vase mari- Tratament: laparatomie cu
hemostaza
- arteriografie+ embolizare
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LEZIUNI ASOCIATE
Aparatul urinarVEZICA URINARA
- Extraperitoneal: peretele anterolateral
- Intraperitoneal: domul (peretele sup.)
URETRA- membranoasa sau portiunea initiala a
- uretrei bulbocavernoase
DIAGNOSTIC
- Sangerarea la nivelul meatului urinar
- Sondaj vezical
- Uretrografie si cistografie
- Cistoscopie
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LEZIUNI ASOCIATE
GENITALE:
Vagin
Uter
INTESTINALE:
Rect Anus iliac URGENTA
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Clasificarea YOUNG
Category Distinguishing Characteristics
LC Transverse fracture of pubic rami, ipsilateral or contralateral to posterior
injury
ISacral compression on side of impact
IICrescent (iliac wing) fracture on side of impact
IIILC-I or LC-II injury on side of impact; contralateral open-book (APC)
injury
APC Symphyseal diastasis or longitudinal rami fractures
ISlight widening of pubic symphysis or anterior SI joint; stretched but
intact anterior SI, sacrotuberous, and sacrospinous ligaments; intact posterior
SI ligaments
IIWidened anterior SI joint; disrupted anterior SI, sacrotuberous, andsacrospinous ligaments; intact posterior SI ligaments
IIIComplete SI joint disruption with lateral displacement; disrupted
anterior SI, sacrotuberous, and sacrospinous ligaments; disrupted
posterior SI ligaments
VS Symphyseal diastasis or vertical displacement anteriorly and posteriorly,usually through the SI joint, occasionally through the iliac wing or sacrum
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TRATAMENT
TRACTIUNEA:- Numai ca tratament
provizoriu
- Grevata de multe complicatiiMANTIA PNEUMATICA
- Tratament de urgenta
- Previne socul(hipotensiunea)
- Ca o imobilizare gipsata
neumatica
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TRATAMENT
CHIRURGICAL
FIXATORUL EXTERN
- Metoda buna de urgenta
- Pentru controlul hemoragiei- Poate ramane si ca tratament
definitiv
- Probleme la pacientii obezi
- Infectii cutanate la fise
- NU stabilizeaza complexulposterior
E necesara tractiune sau OS
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FIXATORUL EXTERN
GANZ
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FIXARE INTERNA
Fixare
sacroiliaca
percutana
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FIXARE INTERNA
Osteosinteza sacroiliaca anterioara
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FIXARE INTERNA
Osteosinteza sacroiliaca anterioara
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FIXARE INTERNA
Osteosinteza simfiza pubiana
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FIXARE INTERNAOsteosinteza simfiza pubiana
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FIXARE INTERNA
Fixare
transiliaca pentrufracturi de sacru
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FIXARE INTERNA
Fixare
transiliaca pentru
fracturi de sacru
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COMPLICATII
INFECTIA- 0-25%
TROMBOEMBOLISMUL
CALUSUL VICIOS
PSEUDARTROZA