3.5 Polarizers
4.1.1 Simulation Methods
4.1.4.1 Testing Numerical Convergence in 3D
CONCLUSIONS
Trauma to the skeletal system is usually attended with destabilising consequences whose severity is dependent on the causative agent, force and site of impact, and the underlying nature of the skeletal system involved as demonstrated by the pelvic injuries.
Consequential associated fracture or multiplicity of and soft tissue complications often more life threatening are looked into. The sequence is aptly demonstrated in this study of the radiologic pattern of pelvic injuries in the Lagos metropolis focused on the normal pelvis subjected to trauma did not include stress, fatigue and pathologic fractures.
The devastation of the pelvis stability is found more with vehicular accidents, domestic/
accidental fall from a height or the normal physiologic process (labour) in that order of descending frequency and severity.
Majority of the patients study revealed that road traffic accident accounted for some 90%
of the cases, followed by domestic/ accidental fall from a height 9% and 1% consequent to labour of vaginal delivery. 26% of the study population also sustained acetabular fracture. Avulsion fracture occurred as 4% while 2% of the patients sustained sacral fracture.
The sutural diastases are seen at the pubic symphysis as 36% and 39% at the sacroiliac joint ranges 11-33 mm with a mean of 16 mm in the male and 8-40 mm with a mean of 18.2 mm in the female. The attendant associated injuries and complications are: vascular, urogenital, neurological, infective, degenerative, respiratory and morphologic/structural defects. Accompaniment skeletal lesion accounted for majority of its complications
In the study, there are 49 males to 51 females the age groups in a descending order are 21-30; 11-20 and 31-40; 41-50, 51-60, 61-70 and 0-10 years old decades.
Road traffic accident results in equal sex distribution and the age group not significantly different from the trend above. The mechanism of injury is, in descending order, due to Knocked down, Passenger in vehicle, Crushed, Head-on collision, Somersault and Fall of moving vehicle accounting for 42.2, 22.2, 15.6, 9.0,7.0 and 4.4% respectively
Domestic/ accidental fall from a height occurs in that order of 11-20, 21-30 and 31-40 and 51-60 years old as 4, 2, 2 and 1 cases respectively in 6 males to 3 females.
There is remarkable promptness of seeking medical attention as seen immediately in 82%
while in 1 week 14%, within 1 month 2 %, 1 month to 1 year 1% and 1% after 1 year of injury.
The study revealed 4 avulsion fractures in 3 males as a result of road traffic accident at the iliac crest and pubic tubercle and a female resultant of fall from a height to produce an avulsion at the pubis tubercle and ischial tuberosity.
Sacral fracture is found in 1 male and 1 female consequent to road traffic accident.
Ruptured bladder with heamaturia, heamorrhage, heamoperitoneum and fracture ilium and bilateral pubic rami fracture accompany the sacral fractures as complications.
Acetabular fracture occurs in 26 patients, 12 males and 14 females as 5 each sex of the central / combined acetabular fracture while all the 4 transverse acetabular fractures are in the female to represent 23.1, 23.1 and 15.4% respectively.
Pelvic ring fracture presents a telltale of pelvic injuries. There are bilateral pelvic ring disruptions in 25 patients (9 males and 16 females) with a distribution pattern of 22 superior and inferior ramal, 1 superior and 2 inferior ramal fractures spread across all the age groups. Right pubic ramal fractures are found in 23 patients (13 male, 10 female), as 17 superior and inferior ramal, 2 superior ramal and 4 inferior ramal fractures. The left pubic ramal fracture occurs in 29 patients (16 males, 13 females) in the form of 20 superior and inferior ramal, 5 superior ramal and 4 inferior ramal fractures.
The sacrum is fractured in only 2 patients in equal sex distribution as a result of road accident crushed injury.
The Ilium is fractured in a total of 16 patients (9 males, 7 females), 1 bilateral, 6 right and 9 left. Road traffic accident accounts for virtually all except 6 cases due to fall from a height.
Ischial fracture occurs in 2 male patients as 1 bilateral and 1 left consequent also to road traffic accident only.
Overall review according to the Tile’s classification shows that: Lateral compression fractures are the commonest with 52% frequency 26% per sex, followed by Anterioposterior compression fractures 31% in 13 males, 18 females, Vertical shear 15%
(7 males, 8 females) while Combined/ complex pelvic fractures occur in 13% (5 males and 8 females).
Pain is the most immediate and lingering complaint but not found to completely incapacitate any of the patients.
RECOMMENDATIONS
The establishments of the various accident victims rescue organizations such as the Lagos State Emergency and Ambulance services, road traffic accident victim rescues organization would help in getting prompt and immediate medical attention.
There is need for sustained public enlightenment campaigns about the desirability of the orthodox orthopaedic management as priority over the so-called traditional “Bone setters” whose patronisers are complicated with limp shortening, limping gait, septic arthritis and the initially dreaded amputation of limb as a consequence of maltreatment.
The use of seat belt should be extended to all passengers to minimize resultant Somersault fractures.
More civility has to be enforced in the driving culture as a means of checking recklessness, carelessness and wanton destruction of lives and properties through road traffic accidents. The road safety corps needs to be more meaningfully concerned about driving habits and roadworthiness conditions of vehicles plying our roads and by extension sanitises the drivers. And more importantly, out rightly enforce banning of night traveling to safeguard against armed banditry and accidents which are almost always fatal with monumental lives and properties loss
The government must treat accident victims as “ conditioned paupers”. Thus, they would benefit from adequate medical attention devoid of official beauraucratic red tapism and the financial implications/ limitations so as to meaningfully benefit from adequate, prompt and valued medical attention. This has to be so because the very rich may be disposed of money resultant to the accident at the time rescue comes by.
REFERENCES
1. Berquist TH et al.: Imaging of orthopaedic trauma, 2nd Edition 1992, Raven press.
2. Nakienly & Chapman: A guide to radiological procedure. 2nd edition 1993 W. B. Saunders.
3. Arogundade RA: The pattern of acquired male urethral stricture seen at the Lagos University Teaching Hospital: Dissertation for the fellowship of the Nigerian National Postgraduate Medical College, Lagos Nigeria 1990.
4. Berquist, TH et al.: Imaging the acutely injured patient. Baltimore: Urban and Schwartzenburg 1985.
5. Rockwood, CA; Green, CP. Fractures in adults. 2nd edition 1984.
Philadelphia JB. Lippincott.
6. Chenoweth DR, Cruickshank B, Gertzbein SD, Goldparb P, Janosaic J: A clinical experimental investigation of occult injuries of the pelvic ring. Injury 1980; 12: 59-65 7. Harris JH Jr., Harris WH, and Novelline RA: The radiology of Emergency Medicine 3rd edition 1993 Williams & Wilkins 693-818.
8. Bavendam FP, Nedelman SH.: Some consideration in Roetogenology of fractures and dislocations seminar. Roentogenol 1966: 407-436.
9. Rothenberger et al: Open pelvic fracture: A lethal injury. J. Trauma 1978, 184-187.
10. Kane WJ: Fractures of the pelvis in Rockwood CA, Green DP. Fractures in adults 2nd edition Philadelphia; J.B Lippincott 1984; 1093-1209.
11. Young JWR, Resnick CS: Fractures of the pelvis, Current concept of classification.
AJR 1990; 155: 1169-1175.
12. Tile M: Pelvic ring fractures; should they be fixed? Bone Joint Surgery 1988, 70 B 1- 12
13. Sampson J, Berquist TH; Pelvic fractures: A review of 750 cases; A study presentation to the American Roentgen rays society. Las Vegas, USA. 1981 14. Muller ME, Nazzarin S, Koch P: Classification AO des fractures 1; Lesos long springer [verlag, Berlin- Heidelberg] New York 1987.
15. Apley System of orthopaedics and fractures. 7th Edition 1993. Butterworth and Heinemann 639-650.
16. Finlay DBL, Allen MJ, Radiological diagnosis of fractures 1st edition 1984, Bailli’ere Tindall.
17. Letournel, E: Acetabular fractures: Classifications and management. Clin. Orthop.
1980. 151: 81-106.
18. Young JWR, Burgess AR, Brumback RJ, Poka A. Pelvic fracture: Value of plain radiography in early assessment and management. Radiology 1986. 160: 445-451.
19. Tile M. Pelvic fractures: operative vs. non-operative treatment. Orthop Clin North Am 1980. 11: 423-464.
20. Tile M. Fractures of the acetabulum. Orthop Clin North Am 1980; 11: 481-506.
21. Tile M. Fractures of the pelvis and acetabulum. 1995 Baltimore, Williams & Wilkins 22. Daffner RH. Pelvic trauma. In: McCort JJ, ed. Trauma radiology 1990. New York, Churchill Livingstone
23. Southern Orthopaedic Association. J South Orthop Assoc 8 (1): 3-13.
24. Young JWR, Burgess AR. Radiologic management of pelvic ring fractures. 1987 Baltimore: Urban and Schwarzenberg.
25. Young JWR, Burgess AR, Brumback RJ, Poka A. Lateral compression fractures of the pelvis: Importance of plain radiographs in diagnosis and surgical management.
Skel Radiol 1986; 15: 103-109.
26. Judet R, Judet J and Letournel E. Fractures of the acetabulum: classification and surgical approaches for open reduction. Journal of Bone and Joint Surgery 1964 46A, 1615-1648.
27. Conoly WB, Hedley EF: Observations on fractures of the pelvis. J Trauma1969 9:104-111.
28. Berquist TH and Covetry MB. The pelvis and hips: In Imaging of Orthopedic Trauma. 2nd Edition. 1992. Raven Press Ltd., New York.
29. Pennal GF, Tile M, Wadell JP, Garside H. Pelvic disruption: assessment and classification. Clin Orthop 1980; 151: 12-21.
30. Heare MM, Heare TC and Gillespy III T. Diagnostic Imaging of Pelvic and Chest Wall Trauma. Radiologic Clinics of North America September 1989 Vol.27, No. 5.
31. Saks BJ. Normal acetabular anatomy for acetabular fracture assessment: CT and plain film correlation. Radiology 1986 159: 139-145.
32. Bowerman JW, Sena JM, Chang R: The teardrop shadow of the pelvis: Anatomy and clinical significance. Radiology 1982 143: 659-662.
33. Malgaigne JF: Traite’ des Fractures et des Luxations. 1855 Paris, JB Bailli‘ere.
34. Malgaigne JF: The classic, double vertical fractures of the pelvis. Clin Orthop 1980 151: 8-11.
35. Pentecost RL, Murray RA, Brindley HH. Fatigue, insufficiency and pathological fractures. JAMA 1964: 187: 1001-1004.
36. Gertzbein SC, Chenoweth DR: Occult injuries of the pelvic ring. Clin. Orthop. 1977 128:202-207.
37. Jackson H, Kan J, Harris JH. Jr, Harris TS. The sacral arcuate lines and upper sacral fractures. Radiology 1982; 145: 659-662.
38. Mears DC, Rubash HE. Pelvic and acetabular fractures. 1986 Thorofare, NJ, Slack.
39. Colapinto V. Trauma to the pelvis: urethra injury. Clin. Orthop. 1980 151: 46-55.
40. MacKenzie EJ, Cushing BM, Jurkovich GJ, et al: Physical impairment and functional outcomes months after severe lower extremity fractures. J
Trauma 1993 34; 528-539.
41. Miranda MA, Riemer BL, Butterfield SL et al: Pelvic ring injuries: a long term functional outcome study. Clin Orthop. 1996 329; 152-159.
42. Brown 33, Greene FL, McMillin RD: Vascular injuries associated with pelvic fractures. Am Sung 1996 50: 150-154.x
43. Tornetta P, Dickson K, Matta JM: Outcome of rotationally unstable pelvic ring injuries treated operatively. Chin Orthop 1996 329:147-151.
44. Copeland CE, Bosse MJ, McCarthy ML et al: Effect of trauma and pelvic fracture on female genital urinary, sexual and reproductive function. J Orthop Trauma
1997 11: 73-81.
45. McCarthy ML, MacKenzie EJ Bosse MJ et al: Functional status following orthopedic trauma in young women. J Trauma 1997 39: 828-832.
46. ColapintoV, McCallum RW: Injury to the male posterior urethra in the fractured pelvis: a new classification. J Urol 1977 118: 575-580.
Appendices Appendix 1.
TYPE OF INJURY
S/N- Serial number I- Initial
A- Age S- Sex C- Cause
R/A-road traffic accident:
C- crushed S- somersault H-head on collision K- knockdown P- passenger
Fv- fall of moving vehicle F- fall from a height D- Duration
ST-immediate report at the hospital
Joint Diastases
Fracture Fr: Undisplaced U, Vertical V, Transverse T, Oblique O,
Comminuted C, Chipped CP, || Sacrum Sm,, Coccyx Cyx,
Avulsion Pelvic ring Acetabular
+: PRESENt
-: absent P+: positive N-: negative
PCT: pelvic compression test
PDT: pelvic distraction test PCDT: pelvic compression distraction test
CHT: chest compression test
Hp: Heamoperitoneum Ht: heamaturia Rb: ruptured bladder Ru ruptured urethra Rv; ruptured viscus PS-Pubic
symphysis S I J- Sacroiliac joint R- right L- left B-bilateral
A- lilac crest B- anterior lilac spine
C- anterior inferior lilac Spine
D- lschial
tuberosity E- pubic tubercle
PR- pubic Ramus S- superior I- inferior IL- ilium ISC- ischium R- right L- left B- bilateral
P- posterior Ramus A- anterior Column C- complex/
Combine T- transverse
S/N I A S C D PS S I J A B C D E P R I L I SC P A C T Sm Cyx Complications
1
2
3 4 5 6 7 8 9 10
11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45
46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 -67 68 69 70 71 72 73 74 75 76 77 78 79 80
81 82 83 84 -85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100
Appendix 2.
TYPE OF INJURY
S/N- Serial number I- Initial A- Age S- Sex C- Cause
R/A-road traffic accident:
C- crushed S- somersault H-head on collision K- knockdown P- passenger
Fv- fall of moving vehicle F- fall from a height D- Duration
ST-immediate report at the hospital
Joint Diastases
Fracture Fr: Undisplaced U, Vertical V, Transverse T, Oblique O, Comminuted C, Chipped CP, || Sacrum Sm,, Coccyx Cyx, Avulsion Pelvic ring Acetabular
+: Present -: absent P+: positive N-: negative
PCT: pelvic compression test PDT: pelvic distraction test
PCDT: pelvic compression distraction test CHT: chest compression test
Hp: Heamoperitoneum Ht: heamaturia Rb: ruptured bladder Ru ruptured urethra Rv; ruptured viscus PS-Pubic
symphysis S I J- Sacroiliac joint
R- right L- left B-bilateral
A- lilac crest B- anterior lilac spine C- anterior inferior lilac Spine D- ischial tuberosity E- pubic tubercle
PR- pubic Ramus S- superior I- inferior IL- ilium ISC- Ischium R- right L- left B- bilateral
P- posterior Ramus A- anterior Column C- complex/
Combine T- transverse
S/N I A S C D PS S I J A B C D E P R I L I
S C
P A C T Sm Cyx
Complications
1 F J 22 M R/A C S +,
11mm
+, B _ _ _ _ _ _ _ _ _ _ _ _ _ _ Ht, Upward shift of the L
hemipelvis.
2 MA 69 F R/A C ST +,
4cm
B _ _ _ _ _ +,L,
S&I
_ _ _ _ _ _ _ _ Open book Fr. suprapubic
tenderness, bladder contusion, and hypostatic pneumonia.
3 SA 65 M R/A K ST _ _ _ _ _ _ _ _ _ _ + U + _ _ _ _ Bregma head laceration,
subluxation of R femur head, tenderness& swelling R thigh, orthostatic pneumonia.
4 I M 14 F R/A K ST + + L _ _ _ _ _ +,L,
S&I C
+L, _ _ _ _ _ _ _ Laceration R leg and greenstick Fr. R Tibia, Fluctuant L hip &
compression Distraction tests positive, Abdominal tenderness with serosangeuous unclotted blood upon abdominal centensis.
5 OF 48 M R/A K ST _ _ _ _ _ _ _ +, L
S&I U
+ L,
_ _ _ _ _ _ _ L Limb shortening, Fr.L 2-7 ribs,
Pelvic & Chest compression tests positive
6 ME 63 F R/A K ST _ R = _ _ _ _ _ +, L,
S&I V
_ _ _ _ _ _ _ _ Pelvic compression test positive.
7 O L 28 F R/A K ST _ _ _ _ _ _ _ +, L + _ L _ _ _ _ _ (C) Fr. L Humerus, Pelvic
S & I O
R, O
+ compression distraction tests
positive.
8 RA 26 M R/A K ST _ R + _ _ _ _ _ _ _ _ _ _ _ _ _ _ Abrasion on head, laceration of L
thigh,,R lower quadrant abdominal guarding with Heamoperitoneum, Pelvic compression test positive.,B Fr.proximal third Femur, R Steernoclavicular dislocation.
9 AR 60 M R/A ST _ _ _ _ _ _ _ _ _ _ _ _ L
+
_ _ _ Heamoarthrosis R hip, Exuberant callus formation, 20OA, and Sciatic nerve. entrapment.
10 NO 45 M R/A ST _ _ _ _ _ _ _ +,L
S&I
_ _ _ _ _ _ _ _ -
11 KB 43 F R/A ST - - - - - - - +,R, I
V
- - - - - - - - PCT P+, Fr. R clavicle.
12 OT 21 M R/A ST - - - - - - - - +,
L U
--
-- - - - - - U Fr. L Ilium.
13 TT 17 F R/A K ST -- - - - - - - +V,
L S&I
- - - - - - - - Fr. Tibia and Fibula.
14 OM 45 F R/A K ST - - - - - - - +, V
R S&I, L S
- - - -- - - -- - Supraorbital Hm, Bruise over R
pubic region.
15 LO 25 M R/A C ST + 33
cm
+ B - - - - - +R
S&I V
+ O
- - - - - - - Marked pubic symphyseal
diastases,
16 OO 38 F R/A ST - - - - - - - + L
S, C
- - - - - - - - L PCT P+, Fr.L Clavicle, CHT
P+, Fr. Ribs.
17 AA 40 M R/A C ST + +, B - - -- -- - +RI
L S&I,
- - - - - - - - Incomplete Rb, Ht.
18 SM 28 F Labour ST +, 15
mm +,B 10 mm
- - - - - - - - - - - - - - Radiating pain to the legs.
19 AA 20 M R/A S ST - +, R -- -- -- - - +,R
S&I +, R
- - - - - - - Rb dome, Ht..
20 RA 21 M R/A C ST - - - - - - - + LS,
R S&I
- - - - - - +,
R
- -
21 RE 37 M R/A K ST - - - - - - - + LS - - - - - - - - Abrasion on temporal skull,
laceration on L arm and Abrasion on R, Scrotal laceration.
22 HO 25 M R/A C ST - - - - - - - +, R
S&I
- - - - - - - - Ht, Fr. Tibia and Fibula
23 AB 40 F R/A C ST + - - - - - - +, L
I
- - - +
L
- - - - Bleeding per Vagina.
24 HU 27 F R/A K ST - +, L - - - - - +, L S&I
- - - - - - - - -
25 CO 65 F R/A K 2\7 + +, B - - - - - +, B
S&I
- - - - - - - - Ht, VVF, Hp, Bladder contusion,
Suprapubic mass Fr. Femur, Tibia and Fibula
26 TA 39 M R/A K ST + - - - - - + +, B
S&I C
- - - - - - - - L
Pneumoperitoneum,,Suprapubic swelling, Ru, Stenosis at Bulbomembranous urethra
27 AM 6 F R/A C ST + + R - - - - - *, L
S&I U
+, B
- - - - -- - - Oesteomylitis of R Ilium,
Extensive laceration over L half of Abdominal wall, laceration over L ASIS, Heamoarthrosis of hips and suprapubic fullness.
28 O N 45 M R/A K ST - - - - - - - +, L
S&I
- - - - - - - - -
29 E N 21 F R/A K ST - - - -- - - - +,L
S, T I , V
- - - - - - - - Fr. Humerus, Radial palsy.
30 I O 16 M FALL ST +,
12mm
- - - - - - - -- - - - - - - - -
31 E O 20 M R/A S ST +,
20mm
+R - - - - - + R
S V, I T
- - - - - - - - R Pelvic asymmetry
32 BA 25 F R/A K ST - - - - - - - + L
I V
- - - - - - - - -
33 J A 30 M R/A K 7/7 - - - - - - - + L
S&I
- - - - - - - - -
34 NA 50 F R/A S 2/7 + - - - - - - +, R
S&I
- - - - +,
R
- - - -
35 EE 45 F R/A K ST - - - - - - - +, L
S&I
- - - - - - - - -
36 WE 27 F R/A K ST + - - - - - +,
B S&I
- - - - - +,
B
- - Transient Ht, Bb subtrancateric Fr proximal third Femur, Fr.
Medial maleolus, scalp laceration.
37 J
B
26 M R/A S 5/7 - - - - - - -- +,
L,S +, L
- - -- - -- - - -
38 T O 22 F
R/A H
1/7 - - - - - - - +, L I
, V
-
--
- - - - - - Hepatitis, Hepatomegaly,ruises
on leg and arm.
39 ID 6 F R/A K ST + + - - - - - - - - - - - - - - -
40 MO 12 F R/A F 1/52 +,
20 m m
+, B
- - - - - - - - - - - - - - -
41 C O 13 F FALL ST + +,
B
- - - - - +, R
S&I +, R
- - - - - - - Trancervical Femoral Fr.& Coxa vara deformity, R Maxilla Le Fort (type 1).
42 LA 25 M R/A 4//7 -- -- -- - - - - +, L - - - - - - - - Fr.L 3-5&9 ribs.
HC S&I
43 YA 30 F R/A K 3/7 +,
15 m m
+ R
- - - - - +, B
S&I V
-- - - - - - - - -
44 N O 20 F R/A K ST - ), R - - - - - - - - - - - - - - Parrapaessis, C Fr. Body 1st
Lumbar vertebra, Fr.R clavicle.
45 T A 20 F R/A K ST - +, L - - - - - +, B
S&I
- - - - - - - - R Colless Fr Radius and Ulnar,
Fr. Ribs, Enuresis, leg injury.
46 R A 34 M R/A S ST - - - - - - - +, R
S7I V
- - - - - - - - Fr. R clavicle.,
47 A A 11 F FALL 6/52 -- - - - - - - - - - - - - + - - Septic arthritis.
48 N O 25 M R/A K ST +, 11
mm
+, B - -- - - -- +, B
S&I V
+ R U
- - - - - - - Floating L S Pubic ramus
fragment, acute abdominal distension relieved by NGT and urinary catheter.
49 B A 25 F R/A K ST - - - - - - - +, B
I U
- - - - - - - - -
50 L O 24 M R/A C ST + + L - - - - - +, L
S&I
- - - - - - - - --
51 C E 30 M R/A C ST - +R - - - - - +, R
S U I T
- - - - - - - - Urinary retention
52 I J 54 M R/A H 5/7 - - - - - - - - - - - - +,
B
- - - Fr. R Humerus
53 K R 18 F R/A F 3YRS + - - - - - - - - - - - - - - - -
54 ML 30 F R/A K 1/52 - - - - - - - +, R
S&I U
- - - - - - - - - Facial abrasion.
55 O N 45 M R/A F 4/7 - - - - - - - +, L
S&I
- - - - - - - - -
56 A E 35 F R/A H 2/7 - - - - - - - - - - - - - +,
R
- - -
57 S A 36 F R/A H 5/12 - - - - - - - - - - - - +,
R
- - - Had native management, R Hip posterior displacement and shortening,
58 I A 24 M R/A H ST - - - - - - - - - - +, L - - - - - Limping gait, L Hip swelling
with posterosuperior
displacement.
59 O S 25 F R/A H 2/52 - - - - - - - +, B
I, CP
- - - - - - - - -
60 A B 40 F R/A C ST + - - - - - - +, R
I
- - - + - - - - R Hemipelvis displacement,
Bladder contusion, R Thigh hemiplegia and Htss,
61 SD 57 M R/A K ST - +, R - -- - - - +, B
S&I
-- - - - - - - - C Fr. L Ankle maleolus
62 K O 39 M R/A ST + +, L - - - - - - +
,L
- - - -- - - - Transient urinary retention
63 A A 48 F R/A ST + +, B - - - - - +,
R I
- - - - - - - - R Limp shortening 3 cm
64 I M 22 F R/A ST - +, R - - - - - -- - - - - +, R
- - - -
65 AW 21 M R/A ST - - - - - - - +, L - - - - - - - - -
66 O D 18 M R/A ST + +, R - - - - - +, L
S&I
- - + - - - - Subtronchateric Fr, R Femur.
-67 C T 30 F R/A K ST - +, L - - - - - +,
R I, L S&I
- - -- - +,
R
- - - Posterior dislocation R Femur, Fr. Fibula
68 C A 45 M R/A K ST - - - - - - - +, L
S
- - - - - - - - Fr.Ribs, clavicle and Humerus
69 MG 54 F R/A K ST - - - - - - - +, R
S&I
- - - - - - - - Subluxation of SIJ,
Stnoclavicular joint
70 O P 23 F R/A ST - - - - - - -- +,R
S&I Body
- - - - - - - - -
71 B N 21 M R/A K ST - +, R - - - - - +, R
S&I, L I TTT
- - - - - - - - Scalp laceration
72 AM 32 M Fall ST + +, L - - - - - +, R
S&I Body
- - - - - - - - -
73 O Y 35 M R/A K ST - - - - - - - +, L
I
- - - - - - - - Fr. C2 vertebra
74 IS 32 M R/A ST - - - - - - - - - - +, L - - - - - Fr. Tibia plateau
75 OS 25 M Fall ST +, 11
mm
- - - - - - +, R
S&I T
- - -- - - -- -- - Fr. Scapholunate bone
76 I I 57 F Fall ST - - - - - + + - - - - - - - - - -
77 M j 43 M R/a ST - - - - - - - +, L
S&I, T
- - -- - - - - - TT Fr. L5 Vertebra
78 A J 30 F R/A ST +, 12
mm
+, B - - - - - +, B
S&I C R, T L
- - - - - - - - Fr. R Clavicle and anterior ribs.
79 P T 20 M Fall ST +, 9
m m
- - - - - - +, L
S&I T
- - - - - - - - -
80 O O 330 M Fall ST - - - - - - - +,
R I
- - - - - - - - --
81 A F 25 F R/A ST +, 8
mm
+, B - - - - - =, R
I U, L S C
+, R U
- - - - - - - Acute urinary retention.
82 O E 30 M R/A ST - +, R - - - - - + R
S
+.L - +.R - +,
L
- - - Ht.,
83 J T 27 M R/A ST +, 18
mm +, L 8mm
- - - - - +, B
S&I
- - - - -- - - - -
84 S O 17 M R/A K ST += -- +, - - - - - - - - - - - - - Paraumbilical tenderness
B
-85 N O 24 F R/A ST - - - - - - - +, R
I
- - - - - - - - Fr. Radius
86 O R 50 F R/A K ST - - - - - - - +, L
I, Body
- - - - - - - - -
87 K L 40 F R/A ST + - - - - - - +,
R I, Body
- - - - - - - - B Fr. Clavicle, Fr. R 11ST Rib.
88 L Y 36 F R/A C ST - + - - - - - + B
S7I
- - - - - - - - Vertical shear and upward
displacement of L Hemipelvis, R SIJ Diastases, Oedema of vulva, Rb, Ht and VVF.
89 K K 48 M R/A K
(hit against gutter)
ST - - + - - - - +, R
S&I
- - - - - - - - Urethral injury with Ru and
stricture at membranous &
proximal bubal urethra, End-to-end anastomosis Urethroplasty, Perineal laceration Ht.,
90 B A 15 F R/A K ST +, 35
mm +, L V
- - - - - - - - - +
T
- - - - Ht., Vulva oedema, swelling Upper R thigh, Distension and guarding over lower abdomen with rebound tenderness
91 J O 22 M R/A Fv ST - - - - - - - +, B
S&I
- - - - - - - - Ht., Intraperitoneal Rb, Hp.and
chemical peritonitis, Floating Prostate, O Fr. B Tibia and Fibula, Suprapubic skin laceration and Pyomyositis.
92 A O 52 F R/A K ST + - - - - - - +, B
S&I
- - - + - - - - V Shear of the Hemipelvis, Open
book Fr., Vagina laceration, Ht..
93 A I 19 F R/A K ST + +, B - - - - - +, B
S&I
- - - - - - - - Fr. Tibia and Fibula.
94 J E 25 M R/A C ST - - - - - - - +, R
S&I +, L
+ ,
L
- - +,
L
- - - V Shear L Hemipelvis Fr., Fr. L Femur.
95 J A 21 F R/A C ST - - - - - - - +, B
S&I +, L
- - - - - + - Hp., Rb, Ht.
96 S A 53 F R/A S ST - - - - - - - +, B
R S, L S&I
- - - - - - - - -
97 WA 44 M R/A H ST - - - - - - - - - - - + - - - - C Fr. L Femur, Fr L 6-7 Ribs.
98 Y A 27 M Fall ST - -- - - - - - +, B
S&I
- - - - - - - - Perineal laceration, Scrotal injury
99 BT 30 F R/A ST - +, B
Post.
- - - - - +, B
S&I V
- - - - + - - - -
100 I J 26 M R/A K ST +,
2cm + 6mm
- - - - - +, R
S&I
- +
, B
- - - - - - -
Appendix 3.
The radiographic pattern of pelvic injury in Lagos
Table 1 Anterior posterior compression fracture 31
No Age Sex Cause Duration Associated fracture Complication/ soft tissue injury
1 22 M RA C ST. Upward shift of Lt. Hemi -pelvis Heamaturia
2 69 F RA C ST. - Bladder contusion, Hypostatic
pneumonia
4 22 F RA C ST. Greenstick fracture R tibia Heamoperitoneum
15 25 M RA C ST. - Marked pubic symphsis diastasis
17 40 M RA C ST. - Heamaturia, incomplete rupture bladder
18 28 F Labor ST. - Radiculopathy
25 65 F RA K ST. Fracture Femur, tibia and fibula VVF, heamaturia, heamoperitoneum
bladder contusion
26 39 M RA K ST. - Pneumoperitoneum, ruptured urethra,
urethral stenosis
27 6 F RA C ST. Fracture ilium Oesteonyelitis, heamoarthrosis of hips
30 16 M FALL ST. - -
34 50 F RA S 2/7 Complex Acetabular fracture -
39 6 F RA K ST. - -
40 12 F RA F 1/52 - -
41 13 F FALL ST. Fracture R ilium, transcervical femoral
fracture, Le Fort fracture type1
Coxa vera deformity
43 30 F RA K 3/7 - -
48 25 M RA K ST. Floating chipped left pubis symphsis ramus
fragments
-
50 24 M RA C ST. - -
53 18 F RA F 3 years -
62 39 M RA ST. - Non closure of Pubic symphsis.
63 48 F RA ST. Complex Acetabular fracture -
66 18 M RA ST. Subtrocaheteric fracture R. femur -
72 32 M FALL ST. - -
75 25 M FALL ST. Fracture scapholunate bone -
78 30 F RA ST. Fracture R clavicle and anterior ribs -
81 25 F RA ST. - -
83 27 M RA ST. - -
87 40 F RA ST. B. Fracture clavicle and R. 11th rib -
90 15 F RA K ST. Fracture acetabulum -
92 52 F RA K ST. Fracture acetabulum, vertical shear
hemisphere
Heamaturia, vulva oedema, Vaginal laceration
93 19 F RA K ST. Fracture tibia and fibula -
100 26 M RA K ST. Ischial fracture -
Table 2 Complex/ combined pelvic fracture 13
No Age Sex Cause Duration Associated fracture Complication/soft tissue injury
4
22 F RA C ST. Greenstick fracture R. Tibia Heamoperitoneum
15 25 M RA C ST. - Marked pubic symphseal diastasis
19 20 M RA S ST. - Rupture dome of bladder
heamaturia
24 27 F RA K ST. - -
44 20 F RA K ST. Commuted fracture body1st lumbar vertebra, fracture R clavicle
Paraparaesis
45 20 F RA K ST. Ribs & Colles fracture R, Enuresis, leg injury
60 40 F RA C ST. R hemipelvis displacement Bladder contusion\, R thigh,
heamiplegia, heamaturia
66 18 M RA ST. Subtrochateric fracture R femur -
67 30 F RA K ST. Fracture fibula, posterior dislocation R femur -
82 30 M RA ST. Fracture acetabulum Heamaturia
88 36 F RA C ST. Vertical shear and displacement< hemipelvis, SIJ diastasis
VVF, heamaturia, rupture bladder
92 52 F RA K ST. Open book fracture, vertical shear hemipelvis Heamaturia, vaginal laceration 94 25 M RA C ST. Vertical shear L hemipelvis fracture L femur -
TABLE 3
Lateral compression fractures
No Age Sex Cause Duration Associated fracture Complication/ soft tissue injury
4 22 F RA C ST. Greenstick fracture R tibia Heamoperitoneum
5 48 M RA K ST. Fracture L 2-7 ribs Limb shortening
6 63 F RA K ST. - -
7 28 F RA K ST. Acetabular fracture, fracture L
humerus
-
10 45 M RA ST. -
11 43 F RA ST. Fracture R clavicle -
12 21 M RA ST. -
13 17 F RA K ST. Fracture tibia, fibula
14 45 F RA K ST. - Supraorbital heamaturia
19 20 M RA S ST. - Rupture bladder dome, heamaturia
20 21 M RA C ST. Acetabular fraction -
21 37 M RA K ST. - Scrotal laceration and abrasion of skull and
arm
22 25 M RA C ST. Fracture tibia and fibula Heamaturia
23 40 F RA C ST. Acetabular fracture Bleeding per vagina
24 27 F RA K ST. - -
28 45 M RA K ST. - -
29 21 F RA K ST. Humerus Radial palsy
32 25 F RA K ST. - -
33 30 M RA K 7/7 - -
35 45 F RA K ST. - -
36 27 F RA K ST. Acetabular fracture, Subtrochateric
fracture proximal 3rd femur , fracture medical maleolus
Heamaturia, ruptured bladder, scalp laceration
37 26 M RA S 5/7 - -
42 25 M RA
HC
4/7 Fracture L 3-5 &9 ribs -
44 20 F RA K ST. Fracture body 1st lumbar vertebra R clavicle
Paraparaesis
45 20 F RA K ST. R Colles fracture radius & ulna, ribs Enuresis
46 34 M RA S ST. - -
49 25 F RA K ST. - -
51 30 M RA K ST. - Urinary retention
54 30 F RA K 7/7 - Facial abrasion
55 45 M RA ST. - -
59 25 F RA K ST. - -
61 57 M RA K ST. Comminuted fracture L tibia maleolus -
65 21 M RA ST. - -
67 30 F RA K ST. Acetabular fracture, fracture fibula Posterior dislocation R femur 68 45 M RA K ST. Fracture ribs clavicle and humerus -
69 54 F RA K ST. - Subluxation of SIJ, sternoclavicular joint
70 23 F RA St. - -
71 21 M RA K St. - Scalp laceration
73 35 M RA K St. Fracture C2 vertebra -
79 20 M RA K St. - -
No Age Sex Cause Duration Associated fracture Complication/ soft tissue injury
80 33 M FALL ST - -
82 30 M RA ST Acetabular fracture Heamaturia
85 24 F RA ST Fracture Radius -
86 50 F RAK ST - -
88 36 F RA C ST Vertical shear, Diastasis SIJ -
89 48 M RA K ST - Uretheral rupture & stenosis, Perineal
laceration, Heamaturia, Urethroplasty done.
91 22 M RA F ST Bilateral fracture Tibia & Fibula Pyomyositis, Heamaturia, Intraperitoneal ruptured Bladder, Heamoperitoneum, Floating Prostate, Chemical peritonitis.
94 25 M RA C ST Fracture L Femur Vertical shear L hemipelvis
95 21 F RA C ST - Heamoperitoneum, Heamaturia, Ruptured
Bladder.
96 53 F RA S ST - -
98 27 M FALL ST - Peritoneal laceration, Scrotal injury.
99 30 F RA ST - -