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Pelvic Fractures

Pelvic fracture is a disruption of the bony structure of the pelvis, including the hip bone, sacrum and coccyx. The most common cause in elderly is a fall, but the most significant fractures involve high-energy forces such as a motor vehicle accident, cycling accidents, or a fall from significant height.

Most pelvic fractures involve high-energy forces, such as those generated in a motor vehicle accident, crush accident or fall. Depending on the direction and degree of the force, these injuries can be life-threatening and require surgical treatment. Also at risk for pelvic fractures are elderly people with osteoporosis. An individual may fracture the pelvis during a fall from standing, such as when getting out of the bathtub or descending stairs. These injuries usually do not damage the structural integrity of the pelvic ring, but may fracture an individual bone.
Because the pelvis cradles so many internal organs, pelvic fractures may produce significant internal bleeding which is invisible to the eye. Emergency treatment consists of advanced trauma life support management. After stabilization, the pelvis may be surgically reconstructed.

Symptoms of a Pelvic Fracture:

  • Pain in the groin, hip or lower back, which may get worse when walking or moving the legs.
  • Abdominal pain, swelling and bruising
  • Numbness or tingling in the groin or legs
  • Difficulty urinating
  • Difficulty walking or standing.

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.

Nonsurgical Treatment

Stable fractures, such as the avulsion fracture experienced by an athlete, will normally heal without surgery. The patient will have to use crutches or a walker, and will not be able to put all of his or her weight on one or both legs for up to three months, or when the bones are healed. The doctor may prescribe medication to lessen pain. Because mobility may be limited for several months, the physician may also prescribe a blood-thinner to reduce the risk of blood clots forming in the veins of the legs.

Surgical Treatment

Pelvic fractures that result from high-energy trauma are often life-threatening injuries because of the extensive bleeding. In these cases, doctors may use an external fixator to stabilize the pelvic area. This device has long screws that are inserted into the bones on each side and connected to a frame outside the body. The external fixator allows surgeons to address the internal injuries to organs, blood vessels and nerves.

What happens next depends on the type of fracture and the patient’s condition. Each case must be assessed individually, particularly with unstable fractures. These injuries often require extensive surgery as well as lengthy physical therapy and rehabilitation.