Pelvic Fractures

Most of us are aware of the fact that any skeletal part of the body has the likelihood to get broken when subjected to high energy forces. We are all aware of the significant bony structure in our lower part of the body. But, have we ever paused to what fracture in the pelvic region would be.

The pelvis is the sturdy set of bones at the end of the spine. It holds and protects the major nerves, blood vessels, and portions of the bowel, bladder, and reproductive organs from injury. It also serves as an anchor for the muscles of the hip, thigh, and abdomen.

Most of the pelvic fractures are due to high energy events, such as a car collision or a fall from a significant height. As the pelvis is in close vicinity to some major blood vessels and organs, a trauma in this area would lead to extensive bleeding and accompanied by injuries to the other organs. Because of which, urgent attention required in the occurrence of this fracture. In some instances, even a minor fall in an older adult with weak bones can cause a fracture to the pelvis.

Fractures to this area are not as common only three per cent of all skeletal injuries are due to pelvic fractures. Of which, open pelvic fracture contributes only two to four per cent of the pelvic fractures. Among the pelvic fractures, about 55% are stable whereas around 25% of rotational instability and the rest are rotational and vertical instability.

•   Pain in the pelvic area. It is often increased by movement of the hip or attempting to walk.
•   Swelling and bruising in the hip area.
•   Numbness or tingling in the genital area or upper thighs.
•   Pain in sitting and when having a bowel movement.
•   Bleeding signs.

In case of unstable fracture, the bleeding might happen inside the body, and the person might seem pale, clammy, unwell or even unconscious. It’s possible to walk around after a significant unstable fracture because shock can initially prevent feeling pain.

Because of the complexity of the fracture, the CT scan uses for a detailed cross-sectional view of the pelvis. Sometimes MRI might be ordered if an X-ray or CT scan can not discover the fracture.

Because the pelvis has a ring-like structure, a fracture in one part of the structure accompanies with damage at another part of it. The specific pattern of the split depends upon the direction of breakage and the amount of force that caused the injury. Pelvic fractures classified as stable or unstable, mainly on the damage that has occurred to the ring structure.

• Stable fracture: There is often only one break in the ring, and the broken ends of the bones line up adequately. It causes due to low-energy events
• Unstable fracture:Here there are usually two or more breaks in the pelvic ring, and the ends of the broken bones do not line up correctly. This fracture occurs in a high-energy event.

Both stable and unstable pelvic fractures can further divide into "open" fractures, where the bone stick out of the skin, or "closed" fractures where the bone doesn’t protrude out of the skin. Open fractures are more severe as a high chance of infection occurring, and immediate treatment needs to provide.

Treatment for the trauma depends on mainly the following factors:

•   The specific pattern of the fracture
•   The number of bones displaced
•   Other injuries sustained
•   Overall medical condition

As always, the treatment for the fracture would depend on the severity of the injury. Sometimes, conservative care might do the trick. While in other cases it might involve surgery to reconstruct the pelvis, to restore stability for the patient to lead a healthy life. With that said, the most common treatment for this is bed rest and prescribed painkillers. The surgical procedure is usually not needed for stable fractures. Crutches and walking aids may be recommended to aid the recovery process. Physiotherapy may be prescribed to keep the muscle strength and mobility. The primary treatment in an unstable pelvic fracture is to stabilise the pelvis using external fixation and to prevent further blood loss and keep the frame still for healing.

Long-term complications due to the trauma may include

•   Pain during the healing process.
•    Nerve damage that may affect mobility.
•   Walk with a limp, particularly if the muscles are damaged.
•   Overall medical condition.