The pelvis is a circular bony structure that protects a number of important internal organs including the bowel, bladder, reproductive organs and the major blood vessels and nerves that supply the legs.
It is made up of two bones that are joined at the lowest part of the spine by the sacrum and at the front by the pubis symphysis.
Causes of Pelvic Fractures
Fractures to the pelvis are often caused by major trauma, for example as the result of a road or bicycle accident, a crush injury or fall from a height. Both horse riding and motorcycle accidents are common occurrence’s of pelvic injuries as the riders have little protection from the forces involved.
Pull-off or avulsion fractures (where the tendon or ligament pulls off a piece of the bone) can happen in high impact sports like football, damaging the rectus femoris muscle. In older people with fragility, pelvic fractures can occur after even a relatively minor trip or fall.
Stable and unstable fractures
Pelvis fractures range in severity, depending which bones are broken and how much force was involved. Even if the pelvis is broken it may remain stable and may heal without surgery in some cases.
However, other types of fracture render the pelvis completely unstable and may require several operations to restore its strength and integrity.
Pelvic fractures can result in major complications due to the risk of damage to internal organs. In some cases, these complications may be life-threatening, with the risk of internal bleeding, blood clots and nerve damage.
It is vital to restore the normal pelvic anatomy to minimise future issues such as hip problems and back and sitting pain.
It is therefore important to have a management and rehabilitation plan after a major pelvic fracture to ensure a good recovery and the restoration of maximum function to the area.
Types of fracture
Among the different types of pelvic fracture are:
- Anterior-Posterior Compression Fractures: these cause the pelvic ring to open (‘open book pelvis fracture’) and can also result in widening of the sacroiliac joints at the back of the pelvis. This injury pattern can cause internal bleeding.
- Lateral Compression Injuries: these occur following impact to the side of the pelvis. There is a risk of damage to the internal organs from the broken bone and a displaced fractures to the pubic bones may also commonly occur.
- Vertical Shear Injuries: these can lead to major pelvic instability and severe internal bleeding. Sacroiliac joints, ligaments and blood vessels can all be damaged by this type of injury.
- Complex Pattern Injuries: these are a mix of two or more of the most common types of pelvic fracture.
Diagnosis and Treatment
If you are suspected of having a pelvic fracture you may need an angiogram to assess for internal bleeding and surgical embolisation to control the bleeding. If there has been a significant loss of blood you may need emergency surgery to pack the pelvis, after application of an external pelvic frame, and prevent further blood loss.
A few days afterwards, you will need further surgery to remove the temporary packing and likely undergo definitive pelvic reconstructive surgery.
After surgery, you will need to follow a rehabilitation programme to manage pain and rebuild the strength of your pelvis. You will be advised by your surgeon how much weight you can put on your legs and you may need to use crutches for the first few weeks. If your injuries are severe you may need to use a rwheelchair for a short period of time. You will need to have blood thinners to minimise the risk of blood clots until you are fully mobile.
You will be given follow-up X-rays to check how well your fracture is healing. If you have sustained injuries to internal organs, such as your bladder, rectum or vagina, you may experience some problems with fertility and/or sexual function. Your surgeon will advise you about this and may refer you for further support from specialist teams.
Mr Andrew Carrothers Specialises in Pelvic Injuries
Diagnosis, Treatment and Management
Mr Carrothers is a specialist in diagnosing and the treatment of pelvic fractures (including acetabular fractures – Hip socket) as well as pelvis soft tissue injuries.
He carried out his Pelvic and Acetabular Fellowship Training at Sunnybrook Hospital University of Toronto – the largest pelvic unit in Canada.