Pelvic Fracture

Pelvic fracture is a disruption of the bony structure of the pelvis, including the hip bone, sacrum and coccyx. Major pelvic fractures result from a very high energy forces such as a motor cycle accident, cycling accidents or falls from a significant height. It is a common cause in the elderly, from a fall.

The majority of pelvic fratures result and require urgent hospital treatment, however, more minor, stable fractures may only require a period of rest.

Because the pelvis cradles so many internal organs, pelvic fractures may produce significant internal bleeding which is invisible to the eye, therefore diagnosis is made on the basis of history, clinical features and special investigations usually including X-ray and CT. After stabilisation, the pelvis may be surgically reconstructed.

One specific kind of pelvic fracture is known as an 'open book' fracture. This is often the result from a heavy impact to the groin (pubis), a common motorcycling accident injury. In this kind of injury, the left and right halves of the pelvis are separated at front and rear, the front opening more than the rear, i.e. like opening a book. Depending on the severity, this may require surgical reconstruction before rehabilitation.

The bony pelvis consists of the ilium (i.e., iliac wings), ischium, and pubis, which form an anatomic ring with the sacrum. Disruption of this ring requires significant energy. Because of the forces involved, pelvic fractures frequently involve injury to organs contained within the bony pelvis. In addition, trauma to extra-pelvic organs is common. Pelvic fractures are often associated with severe hemorrhage due to the extensive blood supply to the region.

Pelvic Injury Classification

Type A:

• Stable injuries: include avulsion fractures, isolated pubic ramus fractures, iliac wing fractures or single stable fractures elsewhere in the pelvic ring.
1. Avulsion fractures occur at the point of attachment of muscles
• Anterior inferior iliac spine: rectus femoris; often resulting from a mis-kick into the ground
• Anterior superior iliac spine: sartorius
• Ischial tuberosity: hamstrings

Type B:

• Rotationally unstable but vertically stable
1. B1: 'open book' anteroposterior compression fractures, causing separation of the pubic symphysis and widening of one or both sacroiliac joints
2. B2: ipsilateral compression causing the pubic bones to fracture and override
3. B3: contralateral compression injury resulting in pubic rami fractures on one side and compression sacroiliac injury on the other side

Type C:

• Rotationally and vertically unstable
• The pelvic ring is completely disrupted or displaced at two or more points. Associated with massive blood loss and a very high mortality.Subdivided into
1. C1: unilateral
2. C2: bilateral
3. C3: involving acetabular fracture