1887

The pelvis and sacroiliac joint

image of The pelvis and sacroiliac joint
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Abstract

Fractures of the pelvis and sacroiliac (SI) joints are common, accounting for 20/30% of fractures in cats and dogs. This chapter covers assessment for surgical or non-surgical management, non-surgical management of pelvic fractures, surgical management of pelvic fractures. Sacroiliac luxation – sacroiliac lag screw placement; Sacroiliac luxation – transilial pinning; Ilial body bone plating – lateral plate application; Ilial body bone plating – ventral plate application in canine patients; Ilial body bone plating – dorsal plate application in feline patients; Simple acetabular fractures – bone plate stabilization; Simple acetabular fractures - composite repair using screws, wire and polymethylmethacrylate.

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Figures

Image of 22.1
22.1 Ventrodorsal view of the pelvis of a dog showing the weight-bearing axes (green arrows).
Image of 22.2
22.2 (a) Ventrodorsal radiograph of canine SI joints. Note the smooth transition between the medial border of the ilial body and the caudal border of the sacrum (arrowed). (b) Ventrodorsal radiograph of a right-sided SI joint luxation in a cat. Note the concurrent ischial and pubic fractures.
Image of 22.3
22.3 Intraoperative image of the left sacral articular surface of a cat. The ilial body has been depressed ventrally by a Hohmann retractor. Note the semilunar appearance to the synovial cartilage. The dot indicates the site for pilot hole placement for this case. The needle is positioned just cranial to the point of drill placement.
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22.4 (a) Ventrodorsal and (b) lateral views of a canine pelvis. A transilial bolt and pin have been used for the management of a sacral fracture. Both implants have been placed dorsal to the sacrum. The animal has had a concurrent contralateral ilial body fracture managed with a string-of-pearls plate and screws placed via a greater trochanteric osteotomy. Transilial implants confer significantly less stability than an SI lag screw and, consequently, should be avoided as the sole means of stabilization of the SI joint if at all possible.
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22.5 Ventrodorsal view of a feline pelvis showing bilateral SI joint luxations managed with two 2 mm lag screws and washers. A concurrent fracture of the left pubis is also present.
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22.6 A ventrodorsal radiograph of a feline pelvis obtained 12 weeks postoperatively. A fracture of the left acetabulum involved the dorsal and medial aspects. The fracture was stabilized with a 2/2.7 mm veterinary cuttable plate applied to the dorsal acetabular rim via a greater trochanteric osteotomy. The fracture of the medial aspect of the acetabulum has healed. A concurrent fracture of the right femur was stabilized with a plate and screws, and a right SI joint luxation stabilized with a 2.4 mm screw and washer.
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22.7 Dorsal approach to the ilium and SI joint. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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22.8 Transverse view of a canine sacrum highlighting the hazards of screw placement. Note the small proportion of the sacral body that is suitable for screw placement and that both ventral and dorsal malpositioning is hazardous.
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22.9 The lateral aspect of a canine sacrum. The white outline indicates the approximate location of the articular cartilage. The correct site for the placement of the screw is at 60% of the dorsoventral axis and approximately midway between the cranial notch and the cranial aspect of the articular cartilage. A black dot indicates the location of the drill hole for the screw.
Image of 22.10
22.10 The lateral aspect of a feline sacrum. The black outline indicates the approximate location of the articular cartilage. The blue circle has been superimposed to demonstrate the circular profile of the feline sacrum. The correct site for placement of the screw is 1 mm dorsal to the geometric centre of the feline sacral wing. A black dot indicates the location of the drill hole for the screw.
Image of 22.11
22.11 Postoperative (a) ventrodorsal and (b) lateral views of the case in Figure 22.2b demonstrating accurate screw placement within the sacral body. The luxation has been stabilized with a 2.4 mm cortical lag screw and a washer. On the ventrodorsal view the screw has been placed across 60% of the sacral width in the true mediolateral plane. Note the sacral surface is angled craniolaterally to caudomedially with respect to the sagittal plane of the patient, therefore the screw is not perpendicular to the sacral surface.
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22.12 The lateral aspect of a canine pelvis demonstrating the site for ilial glide hole placement. The chosen site is located midway dorsoventrally at a point three-quarters of the way between the cranial and caudal dorsal iliac spines. X = distance between the cranial and caudal iliac spines; Y = distance between the dorsal and ventral borders of the ilium perpendicular to the iliac crest.
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22.13 Lateral approach to the ilium. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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22.14 Model demonstrating the application of Kern bone-holding forceps to the ischial table for the manipulation of pelvic fracture fragments.
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22.15 Model demonstrating the application of pointed reduction forceps to the greater trochanter of the femur for the manipulation of pelvic fracture fragments.
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22.16 Approach to the ventral aspect of the ilium. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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22.17 Approach to the dorsal aspect of the acetabulum via a greater trochanteric osteotomy. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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22.18 Intraoperative view of the repair of a feline acetabular fracture. The fracture has been exposed and reduced with a pair of small serrated bone-holding forceps. The surface of the osteotomized greater trochanter is visible. The sciatic nerve has been retracted using a Penrose drain.
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22.19 (a) Lateral radiograph of a feline pelvis showing a caudal acetabular fracture. A sacral fracture was also present. (b) The acetabular fracture has been approached by a greater trochanteric osteotomy, reduced and stabilized with a 4-hole 2 mm acetabular plate. In addition the sacral fracture has been reduced and stabilized with a transilial 2 mm locking plate.
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22.20 Cross-section of the acetabulum to indicate the importance of correct screw angulation. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Image of 22.21
22.21 (a) Lateral and (b) ventrodorsal views of a canine acetabular fracture stabilized with a 1.4 mm K-wire, two 3.5 mm cortical bone screws and a 1.25 mm tension-band wire. The greater trochanteric osteotomy has been stabilized with two K-wires and a tension-band wire. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.

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