Superior gluteal artery injury due to anteroposterior 2 compression injury

Mildly displaced vertically oriented fractures of bilateral superior and inferior pubic rami. Diastatic left sacroiliac joint. Mildly displaced fracture of the right sacral ala. Comminuted open subtrochanteric right femoral shaft fracture with varus deformity. No hip joint dislocation.

Nondisplaced fracture of the right sacral ala extending to the right S1 and S2 neural foramina. Transverse fracture of the left inferior sacral ala without neural foraminal extension. Diastasis of the left anterior SI joint. Acute mildly displaced vertically oriented fractures of both superior and inferior pubic rami without pubic diastasis. Comminuted displaced open right femoral subtrochanteric shaft fracture with varus deformity and air/hematoma within soft tissues of the right proximal thigh.

Contrast extravasation anterior to the left sacroiliac joint.

Left internal iliac artery injection shows contrast extravasation from the proximal left superior gluteal artery Subsequent left common iliac artery injection post-embolization images show occlusion left superior gluteal artery due to embolization coils.

Previously noted fractures and diastasis left sacroiliac joint again noted, embolization coils in the distribution of the left superior gluteal artery.

This patient's injury is not a pure anteroposterior compression injury because of the right sacral fracture, but all of the elements of an AP 2 compression injury are present.

Anteroposterior compression fractures are one of 3 types of pelvic injuries in the Young and Burgess classification of pelvic ring fractures. In anteroposterior compression injuries, a blow to the front of the pelvis results in a force directed from anterior to posterior. An AP1 injury consists of either <2.5 cm diastasis of the symphysis pubis or bilateral fractures of the superior and inferior pubic rami. An AP1 injury is considered stable since the posterior structures responsible for pelvic stability are intact. All AP injuries will have either diastasis of the symphysis pubis or bilateral pubic rami fractures.

With greater forces, one of the innominate bones is externally rotated, resulting in tears of the associated sacrotuberous, sacrospinous, and anterior sacroiliac ligaments with preservation of the posterior sacroiliac ligament, resulting in rotational instability. This is classified as an AP2 injury.

With still more force, the ipsilateral posterior sacroiliac ligament also tears, detaching the involved innominate bone from the rest of the pelvis. This is an AP3 injury.

If you'd like to look at better diagrams of pelvic fractures, click here.

If you'd like to look at an example of a lateral compression fracture, click here.

If you'd like to look at an example of a vertical shear injury, click here.