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Pelvis & Hip - John H. Harris, Jr., MD, DSc*

A. Pelvis
    1. Fractures of isolated bones of the pelvis that do not involve the pelvic ring
        a. iliac wing (Duvrney)
        b. sacrum c. coccyx
        d. 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

     2. Pelvic ring disruption
         Disruption, ie., fracture or diastasis at two or more sites of the anterior and posterior pelvic arcs.
         a. Mechanism of injury
             lateral compression
             anteroposterior compression
             discrete: straddle injury
             diffuse: open-book pelvic ring disruption vertical shear
          b. Types of pelvic ring disruption
              Malgaigne (ipsilateral)
              bucket - handle (contralateral)
              open - book
              other fracture patterns without eponym

3. Insufficiency fractures anterior pelvic arch sacrum

4. Stress fractures

5. Acetabular fractures
    (Involve only one side of pelvic ring. Occur concomitantly with PRD in approximately 12%).
a. posterior column rim (most common)
b. anterior column
c. both columns - above, or through, acetabulum but spare the lunate surface
d. transverse ("T") "T" with ant. column extension "T" with post. column extension

B. Hip
    1. Dislocation
        a. Posterior or posterosuperior pure fracture-dislocation.
            Fracture involves posterior or posterosuperior acetabular rim

        b. Anterior (obturator)
        c. Central
    2. Fractures (usually associated with dislocation).
        a. Posterior or posterosuperior acetabular rim (Case 1) (Case 2)
        b. Anterior (Involve the acetabular "tear-drop")
        c. Central

C. Proximal femur
    1. Slipped capital femoral epiphysis (SCFE)
    2. Salter-Harris physeal injuries
    3. Fractures
        a. Head - usually associated with hip dislocation
        b. Neck subcapital transcervical basicervical
        c. Trochanteric intertrochanteric
            2 - part (proximal/distal fragments)
            3 - part (prox./distal + 1 trochanter)
            4 - part (prox./distal + each trochanter)
                 subtrochanteric isolated fracture, greater trochanter

4. 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

Credits:

AUTHOR: John H. Harris, Jr., MD, DSc*
Case Illustration editor: Manickam Kumaravel, MD, FRCR

*Fellow of the American Society of Emergency Radiology (FASER)

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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