Pelvis and Perineum > Bones and Ligaments > Figures
Plate 353: Pelvis and Perineum—Bones and Ligaments—Bones and Ligaments of Pelvis (continued)
Fig. 5-2-1: Pelvis and lower abdomen after removal of all the organs and most of the vessels to demonstrate the pelvis inlet and cavity. (From Gosling JA, Harris, PF, Whitmore I, et al. Human Anatomy, 4th Edition Mosby, 2005, p. 194, Fig. 5.4)
Fig. 5-2-2: Prosection of right hemi-pelvis. The sites of attachment of the sacrospinous and sacrotuberous ligaments are demonstrated and the lesser and greater sciatic foramina. (From Gosling JA, Harris, PF, Whitmore I, et al. Human Anatomy, 4th Edition Mosby, 2005, p. 208, Fig. 5.26)
Fig. 5-2-3: Radiograph demonstrating the bones forming the pelvis. Note the apparent gap seen at the pubic symphysis which is occupied by radiolucent fibrocartilage. The bones of the pelvic girdle can be seen to form a ‘doughnut shaped’ ring. (From Moses KP, Banks JC, Nava PB, et al. Atlas of Clinical Gross Anatomy. Mosby, 2005, p. 448, Fig. 36.12)
Pelvis and Perineum > Bones and Ligaments > Tables
Table 5-2-1: Structures Passing through Greater and Lesser Sciatic Foramina (Fig. 5-2-2)
Greater Sciatic Foramen
Lesser Sciatic Foramen
Piriformis muscle Sciatic nerve Inferior gluteal nerve and artery Internal pudendal nerve, artery, and vein Nerve to obturator internus muscle Nerve to quadratus femoris Posterior cutaneous nerve of the thigh
Tendon of obturator internus Nerve to obturator internus Pudendal nerve Internal pudendal artery
Pelvis and Perineum > Bones and Ligaments > Facts and Hints
FACTS & HINTS
PART A: HIGH-YIELD FACTS
Box 5-2-1: Anatomic Points
Measurements of the Pelvic Inlet(Plate 354)
Used to determine capacity of female pelvis for childbearing
True conjugate diameter
measured radiologically on a lateral x-ray
distance from superior border of pubic symphysis to sacral promontory
Transverse diameter: widest distance of pelvic inlet
Oblique diameter: distance from sacroiliac joint to contralateral iliopectineal line
Box 5-2-2: Clinical Points
Fractures of the Pelvis
A large force is required to fracture the pelvis and fractures usually result from direct trauma, such as occurs in automobile accidents
The bony pelvis may fracture at any point and there may be associated damage to pelvic viscera, for example, bladder and urethral rupture can occur with fractures involving the pubis
Pelvic fractures are classified as stable or unstable.
In a stable fracture, the pelvis remains stable and there is only one break-point in the pelvic ring with minimal hemorrhage.
In an unstable fracture, the pelvis is unstable with two or more break-points in the pelvic ring with moderate to severe hemorrhage.
Signs of a fractured pelvis include: pain in the groin, hip or lower back; difficulty walking; urethral, vaginal or rectal bleeding; scrotal hematoma; and shock as a result of concealed hemorrhage (contained bleeding into the pelvic cavity)
A fracture can be confirmed on x-ray and is seen as a break in continuity of the pelvic ring. (Fig. 5-2-3)
Box 5-2-3: Clinical Points
Also called pressure sores
Can be a partial- or full-thickness loss of skin, underlying connective tissue and can extend into muscle, bone, tendons, and joint capsules.
Two thirds of pressure sores occur in patients older than 70 years
Results from prolonged pressure on an area of skin, connective tissue and muscle from a mattress, wheelchair seat, or bed rail.
Commonly occur in those with poor mobility, bed-bound, poor nutrition, and incontinence.
Can become infected with bacteria from poor skin care, or fecal or urinary incontinence
The hip and buttock regions account for 67% of all pressure sores, with ischial tuberosity, trochanteric, and sacral locations being most common.
In the sitting position, the ischial tuberosity bears the weight of the whole body and thus is a prime site of ulceration