Fractures of the pelvis are generally high energy injuries. Most pelvic fractures are not life threatening, but in severe cases there may be associated damage to internal organs, nerves and blood vessels inside or outside the pelvis. Severe internal bleeding can result.
The pelvis is a round structure of bones located at the base of the spine, connected to the sacrum of the spine with the help of strong ligaments. The pelvis is composed of three bones, namely the ilium, ischium, and pubis. These become fused together during adolescence. The side of the pelvis is composed of a cup shape socket, known as the acetabulum.
Various organs related to the digestive and reproductive systems lie within the pelvic ring. Also, several large nerves and blood vessels supplying the lower limbs pass through the pelvis. The pelvic ring also acts as point of attachment for muscles from the upper and lower part of the body.
Based on the damage to the pelvic ring and associated structures, pelvic fractures can be categorized as:
- Stable pelvic fractures: broken bones remain in position, and often are not involved in weight bearing; shows less bleeding
- Unstable pelvic fractures: Have breakage at two or more points involving the weight bearing columns of the pelvis. These can be associated with severe internal bleeding. Unstable pelvic fractures may cause shock, extensive internal bleeding, and damage to the internal organs. They require immediate medical care followed by long-term physical therapy and rehabilitation.
Common causes of pelvic fractures include:
- Sports injuries or trauma
- Motor vehicle or motorcycle accidents
- Osteoporosis (especially in the elderly)
- Abrupt muscle contraction
- Falls from a great height
The common symptoms associated with pelvic fractures are:
- Pain and swelling in the groin or hip region that may worsen with ambulation
- Abdominal pain
- Bleeding through the urethra or vagina and the rectum
- Problems in urination
- Unable to stand or walk
The diagnosis of pelvic fracture starts with physical examination including checking the functional activity of the various body organs present in the pelvic region. Imaging techniques such as X-rays, CT (Contrast Tomography) and MRI (Magnetic Resonance Imaging) scan may also be used to confirm the exact condition or breakage of the pelvic bones. In some cases, additional contrasting studies using radioactive dye may be recommended to evaluate the structural and functional activity of organs such as the urethra, bladder, and the pelvic blood vessels.
Treatment of pelvic fractures depends upon the severity of the injury and condition of the patient. Minor or stable fractures can be treated with conservative methods such as rest, medications, use of crutches, physical therapy, and if required minor surgery. These methods may take 8–12 months for complete healing.
The treatment of unstable fractures includes management of the bleeding and injuries of the internal organs, blood vessels, and nerves. This is usually done at a Level I trauma center. Surgical intervention may be employed for fixation of the fractured pelvic bones using screws and plates. Pelvic bone fixation provides stability to the pelvic bone and promotes natural healing of the fracture.