A fracture of the pelvis or acetabulum (Hip socket) is a relatively rare injury, thankfully, but a high impact collision such as a car crash or cycling accident, can fracture the pelvic bones and/or hip socket, sometimes seriously. In older, frail patients or people with osteoporosis (which is weakening of the bones), even a minor incident like a trip or fall can be enough to fracture the pelvis or hip socket.
What is a pelvic fracture?
The pelvis is made up of a ring of bones – the sacrum, which is the triangular bone at the base of the spine, the hip bones (made up of the ilium, acetabulum, ischium and pubis) and the tailbone or coccyx. The pelvic ring protects the bowel, bladder and reproductive organs as well as many major nerves and blood vessels. Powerful ligaments join the pelvis to the sacrum, creating a bowl-like cavity to keep these important structures safe.
Stable and unstable pelvic fractures
You can fracture your pelvis in different ways, depending on the direction and force of the injury, as well as your overall bone health. Stable fractures are the most straightforward to treat as they involve a clean break where the ends of the bones normally line up. These most often occur as the result of a low-impact injury. A sacrum fracture or iliac wing fracture can be types of stable fractures. These fractures may not need surgery but still need two be monitored very carefully to ensure that the fracture position does not slip and that the bones heal as anticipated.
An unstable fracture often involves two or more breaks in the pelvis or acetabulum and the bones may also become displaced. This type of fracture is most often associated with a high-impact injury, such as a road traffic accident, and can be more challenging to treat. Both stable and unstable fractures may either be closed fractures, where the skin is not broken, or open fractures, where bone fragments poke out through the skin and there is a serious risk of infection.
How are pelvic fractures caused?
Some pelvic fractures are caused by a high-impact trauma, such as falling from a height, being involved in a car, motorbike or cycling accident or getting crushed. Such injuries require immediate treatment as they can be life-threatening. If you have weak or insufficient bone density, you may sustain a fracture doing simple everyday activities like getting out of the bath or walking downstairs. This type of fracture tends to occur more often in older people. By contrast, an avulsion fracture is common in young athletes who are still growing and developing. In avulsion fractures, a piece of bone tears away where it is attached to the muscle tendon ( such as the hip flexors or the hamstring muscles).
Diagnosing a pelvic fracture
If you fracture your pelvis, you will experience pain that is made worse by walking or moving. The hip area may appear swollen or bruised and there may be other injuries alongside the fracture. Your orthopaedic team will assess you carefully for injury and nerve damage. You may receive a number of X-rays to determine the extent of the fracture and whether it is stable or unstable. A CT scan is often used to provide a more detailed picture of the pelvis and the injury pattern.
Treating pelvic fractures at Carrothers Orthopaedics
The treatment you receive for a pelvic fracture depends on the type of fracture (stable or unstable, open or closed) and whether there are any associated injuries. If you have a stable fracture where the bones are not displaced, you may be treated non-surgically with walking aids and painkilling medication, with consideration of bone health blood tests and likely bone density DEXA scan. However, for more complex or unstable fractures, you are more likely to need treatments such as external or internal fixation with plates and screws, to stabilise the pelvic or acetabular area.
While stable pelvic fractures tend to heal well, unstable fractures that are caused by high-impact injuries come with a risk of complications such as post traumatic arthritis of the hips and pelvic ring.
Andrew Carrothers, of Carrothers Orthopaedics, is particularly accomplished at treating pelvic and acetabular fractures and the outcomes of his surgery help patients make a good return to their day-to-day life. Andrew has published extensively on this topic and as chief investigator, led a UK NHS funded feasibility trial ‘AceFIT’.
Read Andrew’s peer-reviewed published articles on this topic here.
One patient – whose recovery has been so good that they are back to medal-winning status – recently shared their experience on the review site, Iwantgreatcare.org. The patient wrote:
“I sought advice from Mr Carrothers following multiple pelvic fractures after a cycling accident. He initially gave advice to my local NHS team when I was an in-patient. On follow up, privately, I felt very confident in his clear and reasoned advice on returning to running and cycling and his expertise in the management of pelvic injury. Eight months on my recovery is complete with no residual problems and a gold medal in a European age group championship!”
For more information about the diagnosis and treatment of pelvis fractures, contact us.
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