Pelvic Fracture

The pelvis is a butterfly-shaped group of bones at the base of the spine. The pelvis consists of the pubis, ilium and ischium bones (among others) held together by tough ligaments to form a girdle of bones. With a hole in its center, the pelvis forms one major ring and two smaller rings of bone that support and protect the bladder, intestines and rectum.

Fractures of the pelvis are uncommon and range widely from mild (if the minor ring is broken) to severe (if the major ring is broken). Pelvic rings often break in more than one place. A mild fracture (such as may happen from the impact of jogging) may heal in several weeks without surgery. However, a serious pelvic fracture can be life threatening and may involve damage to the organs the pelvis protects. This type of fracture often needs emergency medical care and lengthy physical therapy and rehabilitation.

Pelvic fractures are classified as:

  • Stable, in which the pelvis has one break point in the pelvic ring, limited bleeding and the bones are staying in place.
  • Unstable, in which there are two or more breaks in the pelvic ring with moderate to severe bleeding.

Both types of pelvic fractures can also be divided into open fractures, in which the skin has been broken by the break, or closed fractures, where the skin is not broken.

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Symptoms

The main symptom of a pelvic fracture is pain in the groin, hip or lower back, which may get worse when walking or moving the legs. Other symptoms may include:

  • Abdominal pain
  • Numbness or tingling in the groin or legs
  • Bleeding from the vagina, urethra (the tube that carries urine from the bladder to the outside of the body) or the rectum (the chamber that contains solid wastes from the large intestine until they are eliminated outside the body)
  • Difficulty urinating
  • Difficulty walking or standing.

A stress fracture that occurs while jogging may cause pain in the thigh or buttock.

Causes and Risk Factors

Most pelvic fractures happen during high-speed accidents (such as car or motorcycle crashes) or falls from great heights. Pelvic fractures can also occur spontaneously or after minor falls in people with bone-weakening diseases such as osteoporosis. Less commonly, pelvic fractures may occur during high-impact athletic activities.

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Diagnosis

A pelvic fracture is usually diagnosed by the presence of bone tenderness, difficulty walking or doing other movements and any loss of nerve function in the lower part of the body. There may be injuries to organs within the pelvic ring such as the intestines, kidneys, bladder or genitals. X-ray will show the fracture.

A computed tomography (CT) scan will be done in complicated cases to get a better picture of the fractures. Depending on how bad the fracture is, other imaging procedures may be needed. This may include contrasting studies where a radioactive dye is injected to create pictures to evaluate organs and structures in the pelvic area, such as the urethra, bladder and blood vessels.

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Treatments

With a potentially serious pelvic fracture (from an accident or high fall), emergency aid should be called. The person with the injury should be covered with a blanket or jacket (so he or she stays warm), and should not be moved by non-trained personnel, especially if there is severe pain or signs of possible nerve injury.

Treatment depends on how bad the injury is. With a minor fracture, the most common treatment is bed rest, nonsteroidal anti-inflammatory medications or prescription painkillers. Physical therapy, the use of crutches and, rarely, surgery may be recommended. Healing can take eight to 12 weeks.

Severe injuries to the pelvis that involve several breaks can be life threatening. Shock, extensive internal bleeding and internal organs damage may be involved. The immediate goal is to control bleeding and stabilize the injured person's condition. These injuries often require extensive surgery as well as lengthy physical therapy and rehabilitation.

In the surgical treatment, the orthopaedic surgeon will put the pelvic bones back together and hold them in place with an internal device, such as:

Pins (surgical screws). This is used if the break is where the thighbone (femur) joins the pelvis (femoral neck fracture) and you are younger and more active, or if the broken bone has not moved much out of place. If you are older and less active, you may need a high strength metal device that fits into your hip socket, replacing the head of your femur (hemiarthroplasty).

Compression screw and side plate. This is used for an intertrochanteric fracture to hold the broken bone in place while it lets the head of your femur move normally in your hip socket.

Plates and screws - Following surgical cleaning of the fracture and reposition of fracture fragments. This is done when the hip socket has fractured (acetabular) fractures.

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