The Pelvis and Hip

Femoral neck | Pubic rami | Sacrum | Complex pelvic fractures | Avulsion fractures
SUFE | Perthes' | Irritable hip | Bone metastases | Pagets

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Learning outcomes
  • Assess skeletal radiographs using a systematic approach
  • Describe pelvic and femoral anatomy
  • Understand mechanisms of injury and the likely fractures/dislocations which may result
  • Search for subtle injuries and understand their clinical significance
  • Accurately describe dislocations and associated fractures
  • Understand common eponyms
  • Recognise potential ligament injuries
  • Understand paediatric anatomy and common paediatric injuries
  • Recognise common pathological conditions seen around the pelvis and femora
Femoral Neck Fractures
Subcapital fracture left neck of femur   Subcapital fracture
Intertrochanteric fracture left femur   Intertrochanteric fracture
Subcapital fracture left neck of femur in external rotation   Subcapital fracture in internal rotation
Missed subcapital fracture left NOF, right rami fractures - first attendance   Missed subcapital fracture left NOF - first attendance   Missed subcapital fracture left NOF - 3 weeks later
Right intertrochanteric fracture, old fracture inferior pubic ramus   Right intertrochanteric fracture
Pubic Rami Fractures
Left rami fractures
Right pubic rami fractures, fracture right ilium, fracture left sacrum
Diastasis symphysis pubis
Malalignment symphysis pubis
Sacral Fractures
Fracture left sacrum, inferior pubic ramus   Disruption of the arcuate lines
L5 transverse process fracture, left ileum fracture
Diastasis left SIJ
Complex Pelvic Fractures

An anterior compression force results in disruption of the SI joints (>4mm), diastasis of the symphysis pubis (>5mm) and external rotation of the hemipelvis. Also known as an "open book" injury:

Anterior compression   Anterior compression
Anterior compression - inlet projection   Anterior compression - outlet projection

A lateral compression force results in oblique fractures of the pubic rami bilaterally (with overlapping fragments), impacted fractures of the sacral foramina ipsilateral to the force, with infolding of the hemipelvis:

Lateral compression   Lateral compression

A vertical shearing injury results in vertical, unilateral fractures of the pubic rami, vertical fracture of the sacral foramina on the same side (or fractured ileum paralleling SI joint/disruption of the SI joint) with the hemipelvis usually displaced superiorly:

Vertical shearing   Vertical shearing

A straddle injury refers to a force against the perineum. This results in fractures of all pubic rami bilaterally with the central fragment displaced superiorly.

Right acetabular fracture with posterior dislocation, diastasis left SIJ, fracture left pubic rami
Avulsion Fractures
Avulsion right ASIS
Avulsion right AIIS with ossification at torn tendon insertion   Avulsion right AIIS with ossification at torn tendon insertion
Avulsion right ischial tuberosity
Avulsion right lesser trochanter
Slipped Upper Femoral Epiphysis (SUFE)
SUFE left hip   SUFE left hip
SUFE right hip   SUFE right hip
Perthes' Disease
Perthes' right hip   Perthes' right hip
Irritable Hip
Bone metastases
Bony metastases   Metastatic lesion left intertrochanteric region   Metastatic lesion left femoral neck
Pathological fracture through metastatic lesion   Pathological fracture through metastatic lesion
Paget's Disease
Paget's disease left femur   Paget's disease right hemipelvis

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