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By Ayaat Ashi Pelvis Contents Bones Muscles Urogenital Terminal digestive Hip bones Sacrum Cavity Diaphragm system system Sigmoid Ilium Piriformis Levator Ani Bladder colon Sacrospinous lig Uterus Ischium Sacrotuberous lig Obturator Coccygeus Rectum internus Ovaries Anal Canal PubisPelvic Osteology (Teach me series, The pelvis 2023)SBA A 88 year old woman comes into A&E after experiencing falling over when trying to stand up from her chair. She is experiencing pain made worse by moving the hip or trying to walk but can still walk. She’s also experiencing tingling in the genital and upper thigh area and has told the Dr that she has bruising in this area. What could be the possible diagnosis? A) Pubic Rami fracture B) Intracapsular fracture of the femur C) Open book fracture D) Extracapsular fracture of the femur E) Inflammation of the pelvic muscles causing compression of the pudendal nerveSBA A 88 year old woman comes into A&E after experiencing falling over when trying to stand up from her chair. She is to walk but can still walk. She’s also experiencing tingling in the genital and upper thigh area and has told the Dr that she has bruising in this area. What could be the possible diagnosis? A) Pubic Rami fracture B) Intracapsular fracture of the femur C) Open book fracture D) Extracapsular fracture of the femur E) Inflammation of the pelvic muscles causing compression of the pudendal nerve Clinical Points Pubic Rami Fractures Pubic rami fractures can be observed in elderly patient X rays after simple low ASIS energy falls from standing height • Mid inguinal point – halfway between ASIS and pubic symphysis Treated without surgery within 6-8 weeks • femoral artery palpated here • A patients true leg length is measured from ASIS to medial malleolus of ankle • Apparent leg – umbilicus to medial malleolus • True leg length discrepancy is a feature of various hip disorders, as well as being a potential complication of hip joint replacement (arthroplasty).Femur head fractures Extracapsular Intracapsular • Outside of the hip joint capsule, • In femoral neck from the greater trochanter and • More likely in older adults with below. osteoporotic joints • Less risk of avascular necrosis of • These can break off vascular supply the femoral head as they don’t to the femoral head and cause involve the femoral neck avascular necrosis, lack of blood supply to the head. (esp as the head • Fixed by dynamic hip screws or can get displaced) intermedullary nails • Fixed with hip screw , hemi arthroplasty (partial replacement of The vasculature – medial and lateral the hip joint) circumflex femoral arteries (Pseudo-aneurysmof thelateral circumflex femoral arteryafter femoral neck fracture– a casereport 2020)Male Vs Female • Gynecoid – wider broader than android • Lighter in weight • Oval shaped (male heart shaped) • Less prominent ischial spines – greater bispinous diameter • Greater angles sub pubic arch >80-90 degrees • Shorter more curved sacrum, less pronounced sacral promontory (Teach me series, The pelvis 2023) Pudendal nerve • Mixed nerve • Sensory and motor supply to the perineum and external genitalia (Teach m2023)ies , The pudendal nerve • Arises from pelvic cavity from sacral plexus • Ant rami of spinal nerves S2, S3, S4 • Leaves pelvic cavity through greater sciatic foramen àhooks around the ischial spine à enters the perineum through the lesser sciatic foramen (Pudendal nerve.svg 2023) Ligaments and muscles (Teach me series, The pelvis 2023) (Anatomy of the pelvic cavity: Video & Anatomy) (Teach me series, The pelvis 2023)Pelvic diaphragm (Teach me series, The pelvis 2023) Signs and symptoms related to the abnormal functioning of the Pelvic floor dysfunction pelvis floor muscles In women, pelvic floor muscles support; • Urethra • Vagina • Anal canal Weakness leads to; • Urinary and faecal incontinence • Genitourinary prolapse • Pelvic pain • Sexual dysfunction (Pelvic floor dysfunction/prolapse 2023) Causes are multifactorial – obstetric trauma, age, obesity, chronic strainingReferences • https://www.sciencedirect.com/science/article/pii/S2352644020300753 • The pudendal nerve (no date) TeachMeAnatomy. Available at: https://teachmeanatomy.info/pelvis/other/pudendal-nerve/ (Accessed: 29 November 2023). • The pelvis (no date) TeachMeAnatomy. Available at: https://teachmeanatomy.info/pelvis/ (Accessed: 29 November 2023). • Anatomy of the pelvic cavity: Video & Anatomy (no date) Osmosis. Available at: https://www.osmosis.org/learn/Anatomy_of_the_pelvic_cavity (Accessed: 29 November 2023). • Phttps://thebackbone.co.uk/pelvic-floor-dysfunction/ (Accessed: 29 November 2023).le at: • File:Pudendal nerve.svg (no date) Wikipedia. Available at: https://en.wikipedia.org/wiki/File:Pudendal_nerve.svg (Accessed: 29 November 2023).Thank you