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A 27-year-old construction worker fell from a 6-feet high scaffolding.
He was hemodynamically stable and had no signs of head, chest, or
abdominal trauma. His pelvis was stable but tender to compression.
There was an obvious fracture of his wrist.
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- Are there any abnormalities on his pelvis radiograph? (see Figure 1)
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Because the pelvis has a rigid ring-like structure, a single
break in the pelvis, especially if displaced, is nearly always associated
with a second break elsewhere in the ring. If not immediately obvious,
a second fracture must be carefully sought. The same principle holds
true for fractures of the obturator ring (Figure
2). A single break in the obturator ring must be accompanied by
another break elsewhere in the ring. For example, a superior pubic
ramus fractures is often associated with an inferior pubic ramus
fracture.
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In Patient 5, there is deformity
of the left side of the pubic symphysis (Figure
3A). This is due to a fracture through the body of the left pubic
bone. The fracture is better seen on an “outlet” view
(Figure 3B). This is an unusual location for a fracture; most obturator ring
fractures occur through the superior or inferior pubic rami.
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With a pubic bone fracture, a typical site for the second fracture
is the acetabulum. Detection of fractures
in this region requires knowledge of radiographic anatomy of the
acetabulum. Interpretation of the radiograph is aided by the symmetry
of the pelvis, which provides an opposite side for comparison.
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The Radiographic
Teardrop
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There are several radiographic landmarks that are important in
identifying acetabular fractures (Figures 4 and 5). The iliopubic line...