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PELVISKaan Ycel M.D., Ph.D.14.January.2014 Tuesday

CLINICAL ANATOMY OF THE

Sexual differences are related mainly Heavier build and larger muscles of most men Adaptation of the pelvis (particularly the lesser pelvis) in women for parturition (childbearing). Male Pelvis v.s. Female Pelvis

The difference between the male and female pelvisDifference Between Male & Female Pelvis

41% of womenmale or funnel-shaped pelvis with a contracted outletlong, narrow, and oval shapedwide pelvis 2% of womenIn forensic medicine (the application of medical and anatomical knowledge for the purposes of law), identification of human skeletal remains usually involves the diagnosis of sex.

A prime focus of attention is the pelvic girdle because sexual differences usually are clearly visible.

Even fragments of the pelvic girdle are useful in determining sex.

FeatureMale pelvisFemale pelvisGeneralStructureThick & Heavy Thin & LightGreater pelvis Deep ShallowLesserpelvis Narrow and deep, taperingWide and shallow,cylindiricalPelvic inlet Heart-shaped, narrow Oval and rounded, wide

Pelvic outletComparatively smallComparatively large

Ischial spines Project further medially into the pelvic cavity Do not project as far medially into the pelvic cavity & smoothFeatureMale pelvisFemale pelvisObturatorforamenRoundOvalAcetabulumLargeSmallGreater schiatic notchNarrow, inverted V(approximately 70 degrees)Almost 90 degreesSubpubic angleSmaller (50-60 degrees) Larger (80-85 degrees)Sacral promontoryProminentNot prominent

Size of the lesser pelvis important in obstetrics

Because it is the bony canal through which the fetus passes during a vaginal birth.

To determine the capacity of the female pelvis for childbearing, diameters of the lesser pelvis are noted radiographically or manually during a pelvic examination. PELVIC DIAMETERS (CONJUGATES)

PELVIC DIAMETERS (CONJUGATES)

Anatomical antero-posterior diameter 11cmfrom tip of the coccyx to lower border of symphysis pubis

Obstetric antero-posterior diameter 13 cmfrom tip of the sacrum to lower border of symphysis pubis as the coccyx moves backwards during the second stage of labour.

Diameters of pelvic outletAntero - posterior diameters

Bituberous diameter 11 cmbetween inner aspects of ischial tuberosities

Bispinous diameter 10.5 cmbetween tips of ischial spines

Diameters of pelvic outletTransverse diameters

Anatomical antero-posterior diameter True conjugate 11cmfrom tip of sacral promontory to upper border of symphysis pubisDiameters of pelvic inletAntero - posterior diameters

Obstetric conjugate 10.5 cmfrom tip of sacral promontory to the most bulging point on back of symphysis pubis ,about 1 cm below its upper border. shortest antero-posterior diameterDiameters of pelvic inletAntero - posterior diameters

Diagonal conjugate 12.5 cm1.5 cm longer than the true conjugateFrom tip of sacral promontory to lower border of symphysis pubis

Diameters of pelvic inletAntero - posterior diameters

Minimum anteroposterior (AP) diameter of the lesser pelvisTrue (obstetrical) conjugate

Narrowest distance through which the baby's head must pass in a vaginal delivery. This distance, however, cannot be measured directly during a pelvic examination because of the presence of the bladder.

Diagonal conjugate (from inferior pubic lig. to promontory) Measured by palpating sacral promontory with the tip of the middle finger, using the other hand to mark the level of the inferior margin of the pubic symphysis on the examining hand.

After the examining hand is withdrawn, the distance between the tip of the index finger (1.5 cm shorter than the middle finger) and the marked level of the pubic symphysis is measured to estimate the true conjugate, which should be 11.0 cm or greater.

Transverse diameter is the greatest distance between the linea terminalis on either side of the pelvis.

Anteroposterior compression of the pelvis occurs during crush accidents (as when a heavy object falls on the pelvis).

This type of trauma commonly produces fractures of the pubic rami.

When the pelvis is compressed laterally, the acetabula and ilia are squeezed toward each other and may be broken.

Pelvic FracturesFractures of the bony pelvic ring are almost always multiple fractures or a fracture combined with a joint dislocation.

Pelvic fractures can result from direct trauma to the pelvic bones, such as occurs during an automobile accident, or be caused by forces transmitted to these bones from the lower limbs during falls on the feet.

Weak areas of the pelvis, where fractures often occur:Pubic ramiAcetabula Region of the sacroiliac jointsAlae of the ilium

25 Year Old Male with displaced fracture of the sacrum andsymphysis pubis.The most severe pelvic fractures separate the two sides of the pelvis from each other.

Pelvic fractures may cause injury to pelvic soft tissues, blood vessels, nerves, and organs.

Fractures in the pubo-obturator area are relatively common and are often complicated because of their relationship to the urinary bladder and urethra, which may be ruptured or torn.

Sacroiliac joint dysfunctionDegenerative arthritis (osteoarthritis) PregnancyGoutRheumatoid arthritisPsoriasisAnkylosing spondylitis

X-ray of the sacroiliac joints showing joint space narrowing, erosive change and indistinct margins, due to sacroiliitis

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