Avulsion and single-bone fractures:Occur as a result of direct trauma from falls or from forceful muscle contrac-
tion (see Figure 3.15)SYMPTOMS
■ Pain and tenderness of pelvis: Worse with ambulation
■ Perineal/pelvic edema/ecchymosis/lacerations/deformities
■ Hematomas above inguinal ligament or over scrotum (Destot sign)EXAM
■ Medial or posterior compression of pelvis at iliac crests or posterior com-
pression at symphysis pubis can demonstrate instability. If instability exists,
minimize further movement of the pelvis.
■ Rectal and perineal exam
■ Evaluate perineum for lacerations to exclude open pelvic fracture,
which if present require antibiotics and operative repair.
■ Palpate rectum for hematoma, tenderness, or bony prominence (Earle
sign).
■ Evaluate sphincter tone to assess for neurologic deficit.
■ Evaluate for gross blood, suggesting rectal injury.
■ Palpate prostate for superior or posterior displacement suggesting intra-
peritoneal or urologic injury. Abnormal prostate position or blood at
the urethral meatus requires urethrogram prior to Foley placementto
assess for urethral injury.DIAGNOSIS
■ Initial AP plain film of pelvis will show most fractures.
■ Displacement of ring fractures may be better defined with inlet view
(superior-inferior) and outlet view (anterior-posterior).TRAUMA
FIGURE 3.15. Avulsion fractures of the pelvis. 1. Iliac wing fracture (Duverney fracture).- Superior pubic ramus fracture. 3. Inferior pubic ramus fracture. 4. Transverse sacral fracture.
- Coccyx fracture. 6. Anterior superior iliac spine avulsion. 7. Anterior inferior iliac spine
avulsion. 8. Ischial tuberosity avulsion.
(Reproduced, with permission, from Tintinalli JE, Kelen GD, Stapczynski JS. Emergency
Medicine: A Comprehensive Study Guide, 6th ed. New York: McGraw-Hill, 2004:1718.)Three types of pelvic fractures:
Lateral compression (most
common)
AP compression
Vertical shearOne-third of all pelvic
fractures involve individual
bones but not the ring.