Fractures of the Pelvis

Chapter 107 Fractures of the Pelvis



Pelvic fractures in dogs and cats are extremely common. Severe trauma, such as motor vehicular accidents, is usually the cause of pelvic fractures. Concurrent injuries to other body systems, including life-threatening injuries, are also common and must be identified and treated in a timely fashion. Several specific types of injury occur in the pelvis, including sacroiliac luxation, fractures of the non-articular portions of the pelvis, and articular fractures. Specific management protocols for each are described below.



ANATOMY










DIAGNOSIS




Concurrent Thoracic and Abdominal Injuries




Treat aggressively for shock and pain (see Chapters 6 and 156). After emergency treatment, complete the general physical examination as soon as possible.









Pelvic Injuries















TREATMENT




Non-surgical Treatment


In many animals with pelvic fractures, conservative treatment is all that is needed for successful fracture healing and normal pelvic limb function. However, careful nursing is required for several weeks because multiple fractures are often present. Patient size is an important consideration in making the decision to manage pelvic fractures without surgery. Small dogs and cats are much easier to manage for extended periods of time.




Nursing Care













Surgical Treatment



Indications




Pelvic fractures may result in marked narrowing of the pelvic canal if left untreated, with the risk of subsequent obstipation, dystocia, dysuria, or sciatic nerve entrapment. If operative treatment of pelvic fractures is delayed beyond 5 days, muscle spasm and fibrosis may make reduction of the fracture fragments difficult, because of the large muscle mass surrounding the pelvis.


Surgical treatment is indicated for the following injuries:










FRACTURES OF THE ILIUM





Surgical Procedure





Technique






4. Identify and separate the tensor fasciae latae and middle gluteal muscles. Retract the tensor fasciae latae muscle ventrally, and retract the middle gluteal muscle dorsally to expose the ilium (Fig. 107-3). Subperiosteal elevation of the middle and deep gluteal muscles ventrally from the surface of the ilium exposes the lateral surface of the body of the ilium. Retract the sartorius muscle cranially as needed. Remember that there is little to no plane of dissection at the confluence of sartorius, middle gluteal muscles, and tensor fasciae latae. Sharply incise these muscles where they join and continue the dissection dorsally along the cranial edge of the iliac crest as needed to “roll up” the gluteal to provide adequate exposure of the ilium. The iliolumbar artery is present along the ventral edge of the cranial ilium in these muscles and is usually severed during the muscular dissection. Electrocoagulate or ligate this artery when it is encountered.

Aug 27, 2016 | Posted by in SMALL ANIMAL | Comments Off on Fractures of the Pelvis
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