Pelvic Fractures

Pelvic Fractures

Pelvic Fractures

The pelvis is a strong ring of bone located at the base of the spine. Pelvic fractures are rare; they account for only about 3% of all fractures in adults.

Pelvic fractures usually result from high-energy trauma. For example, car accidents or falls from heights are among the most common causes of pelvic fractures. Because the pelvic bones are close to major blood vessels and organs, these fractures can lead to serious bleeding and other injuries requiring emergency intervention.

Lower-energy traumas can also cause pelvic fractures, particularly in older individuals with bone weakness such as osteoporosis. Treatment for pelvic fractures varies depending on the severity of the injury: low-energy fractures can often be treated non-surgically, while high-energy fractures usually require surgery.

Anatomy

The pelvis is a bony ring located at the base of the torso, situated between the spine and the legs. The bones that make up the pelvis include:

• Sacrum: The large, triangular bone at the base of the spine.
• Coccyx: Commonly known as the tailbone.
• Hip Bones: Comprising the ilium, ischium, and pubis.

In childhood, each hip bone consists of three separate bones (ilium, ischium, and pubis) that eventually fuse together to form the acetabulum. This structure serves as the socket for the “ball and socket” hip joint.

The pelvic ring serves as a passageway for critical nerves, blood vessels, and portions of the intestines, bladder, and reproductive organs. The pelvis protects these vital structures from injury and provides an anchor point for the muscles of the hip, thigh, and abdomen.

Definition of Pelvic Fractures

Because the pelvis is a ring-like structure, a fracture in one area is often accompanied by damage to ligaments or bones at another point in the ring. Fractures are commonly classified into two categories: stable and unstable.

Stable Fracture

In a stable fracture, there is usually only one break in the pelvic ring, and the broken ends of the bones remain properly aligned. These typically result from low-energy trauma.

Types of stable fractures:

• Iliac wing fracture
• Sacrum fracture
• Superior pubic ramus fracture
• Inferior pubic ramus fracture

Unstable Fracture

An unstable fracture involves two or more breaks in the pelvic ring where the bone ends are not correctly aligned (displaced). These are the result of high-energy trauma (such as motor vehicle accidents or falls from significant heights).

Types of unstable fractures:

• Anteroposterior (AP) compression fracture: Often referred to as an “open book” injury.
• Lateral compression fracture: Caused by a side-impact force.
• Vertical shear fracture: Occurs when one side of the pelvis shifts upward.

Open vs. Closed Fractures

Fractures are also classified based on skin integrity:

• Closed fracture: The skin remains intact.
• Open (Compound) fracture: The bone breaks through the skin or communicates with an external wound. Open fractures require emergency treatment due to the high risk of infection and potential internal organ damage.

Reasons

High-Energy Trauma: These fractures are usually the result of significant force and often occur in younger patients. Common causes include:

• Automobile or motorcycle accidents
• Crush injuries
• Falls from significant heights

Bone Insufficiency: In elderly patients with weakened bones, such as those with osteoporosis, the structural integrity of the pelvis is compromised. In these cases:

• Even low-energy falls (like slipping from a standing position) can lead to fractures.
• These are often stable but require careful management to ensure the patient regains mobility.

Other Causes — Avulsion Fractures: An avulsion fracture occurs when a small piece of bone attached to a tendon or ligament is pulled away from the main bone.

• This is commonly seen when the hamstring muscles pull away from their attachment point on the pelvis.
• It usually occurs in young athletes during sudden, forceful movements.
• Unlike high-energy trauma, an avulsion fracture typically does not disrupt the overall stability of the pelvic ring.

Symptoms

• Pain and tenderness in the hip
• Pain that worsens with movement or walking
• Tension to keep the hip or knees bent
• Swelling or bruising in some cases

Diagnostic Methods

When a pelvic fracture is suspected, the following methods are used to determine the severity of the injury and identify any accompanying internal organ damage:

• Radiological Imaging: In the initial stage, X-rays are used to examine the bone structure. Computed Tomography (CT) is a standard procedure to clearly visualize the details of the fracture and its relationship with the joints.
• Physical Examination: Hip stability, nerve functions, and blood circulation (vascular status) are carefully checked.
• Additional Tests: If internal organ injury (bladder, intestines, or blood vessels) is suspected, ultrasound or contrast-enhanced imaging techniques may be utilized.

Treatment Methods

1. Non-Surgical (Conservative) Treatment: Surgery is generally not required for stable fractures where the pelvic ring remains intact and aligned.

• Rest and Activity Restriction: To allow the bone to heal (union), weight-bearing on the affected side is restricted.
• Assistive Devices: The use of crutches or a walker is recommended to maintain mobility without stressing the fracture site.
• Medication: Pain relievers are prescribed along with anticoagulants (blood thinners) to prevent deep vein thrombosis (DVT) during the period of reduced mobility.

2. Surgical Treatment: Surgery is necessary for unstable or high-energy fractures to realign the pelvic ring and ensure structural stability.

• External Fixation: Metal pins are inserted into the bone through small incisions and connected to a frame outside the body. This is often used as an emergency measure to stabilize the pelvis and control bleeding.
• Internal Fixation (Plates and Screws): Also known as ORIF (Open Reduction and Internal Fixation). The bone fragments are realigned through a surgical incision and secured internally with specialized metal plates and screws.

Recovery Process and Rehabilitation

The healing process for pelvic fractures requires significant time and patience. Here is the translated guidance for the recovery period:

• Physical Therapy: The rehabilitation process is critical for regaining mobility and preventing muscle atrophy (weakness). It typically begins with gentle range-of-motion exercises before progressing to weight-bearing activities.
• Healing Timeline: Complete bone union (healing) usually takes 3 to 6 months. However, in cases of severe or unstable injuries, returning to full functional capacity can take up to a year.
• Important Note: Pelvic fractures are serious injuries. If you are experiencing severe hip pain, numbness in the legs, or loss of mobility, you should consult Associate Professor Serkan Sürücü, MD, without delay.

Mechanism of Injury and Initial Assessment

Pelvic Fractures can follow anything from a low-energy fall to a high-energy road-traffic or sporting injury. The first assessment checks more than the fracture line: skin integrity, swelling, limb alignment, circulation and nerve function all matter. An open wound, marked deformity, a cold or pale limb, or progressive numbness needs urgent assessment, and the injury should never be manipulated at home.

Return to Daily Life and Prevention

Return to work and sport after Pelvic Fractures depends on healing together with motion, strength, balance and the ability to perform the task safely. Reducing fall risk, using appropriate protective equipment and assessing conditions that affect bone health can lower the chance of another injury. The next step should reflect the diagnosis, the demands placed on the joint and the patient's goals. You can review hip and pelvic care, read about acetabular fractures, or request an assessment for an individual plan.

Continue with hip and pelvic care, acetabular fractures and hip arthritis, or use contact and appointments for an individual assessment.