What are pelvic fractures?

Pelvic fractures are breaks in the pelvis.

Causes

High impact trauma from any of the following can cause this injury:

● Motor vehicle accident
● Fall
● Pedestrian accident
● Motorcycle crash

The forceful impact from a severe accident can result in serious injuries to organs contained within the bony pelvis.

o Severe hemorrhages, due to blood supply in the region, are often linked to pelvic fractures; consequently, this type of injury has a high mortality (death) rate compared to a traumatic injury without a pelvic fracture.
o Unfortunately, elderly patients with pelvic fractures have a worse outcome than younger patients with similar injuries.
o Complications consist of increased risk of deep vein thrombosis (DVT); continuous bleeding from the fracture; genitourinary (GU) problems; urethral, prostate, or vaginal injuries; sexual dysfunction; infection from disruption of the bowel or urinary system.
o These complications can lead to multiorgan system failure.

Signs and symptoms

The signs and symptoms of pelvic fractures are significant with blunt trauma.

● Intense pain
● Inability to ambulate at the scene of the accident
● Bowel and bladder incontinence
● Complaints of numbness or weakness of the lower extremities
● Hematuria (blood in the urine)
● Hematomas (blood that pools underneath the skin resulting in a bad bruise) over the ipsilateral flank, inguinal ligament, proximal thigh
● Rectal bleeding

Treatment

If you or someone you know experiences any of these signs and symptoms, call 9-1-1 immediately and go to the nearest emergency room (ER) for treatment.

Treatment may include:

● Labs drawn to assess ongoing blood loss
● Blood transfusion(s)
● Urinalysis to assess blood in the urine
● Diagnostic images of anterior (front) and posterior (back) pelvic X-rays
● Computed tomography (CT) scan
● Magnetic resonance imaging (MRI) to confirm pelvic fractures

Based on the results of your tests, you may be met with multiple specialists to help with your treatment, which is based on the specific patterns of the fracture, the amount of bone displaced, and the overall severity of injuries.

o Medication will be prescribed to relieve the pain.
o Anticoagulants will be administered to decrease the risk of blood clots forming in the veins of the legs.

● Nonsurgical treatment is recommended for stable fractures in which the bones are nondisplaced or minimally displaced.

o Patients with this diagnosis will be required to use crutches or a walker to avoid weight-bearing on the affected hip/leg until bones are fully healed.
o Bilateral hips/legs injured will require the use of a wheelchair.
o Physical therapy will be scheduled when the patient is ready for this stage of treatment.

● Surgical treatment for unstable pelvic fractures may include external fixations (metal pins and screws are inserted into the bones) to stabilize the pelvis until the bones heal completely.

o Skeletal traction, which is a pulley system of weights and counterparts, help realign the pieces of bone and can also provide pain relief.
o Skeletal traction is used immediately after the injury and removed after surgery.
o Another possible option is open reduction and internal fixation, which is an emergency surgery when bones are broken in multiple areas and are protruding through the skin.
o Open reduction and internal fixation require the insertion of pins, rods, and screws into the bones until healed.

● Physical therapy can begin as soon as your orthopedic physician determines that your hip and pelvis can bear some of your body weight.

Figure 1: Left Pelvic Fracture.

References

Kleweno, C. P., Scolaro, J., Sciadini, M. F., McAlister, I., Shannon, S. F., & Chip Routt, M. L. (2020). Management of Pelvic Fractures. Instructional course lectures, 69, 489–506

OrthoInfo. (2021). Pelvic Fracture. https://orthoinfo.aaos.org/en/diseases–conditions/pelvic-fractures/

Solar22. (2021). [Illustration]. Fractures of the pelvic. https://www.shutterstock.com/image-vector/fractures-pelvic-illustration-body-injury-diagram-585525356

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