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Pelvic Fracture – Causes, Symptoms and Treatment

A pelvic fracture is a break in one or more bones of the pelvis, often caused by accidents or falls. It can be life-threatening and requires immediate medical attention.

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Things worth knowing about "Pelvic Fracture"

A pelvic fracture is a break in one or more bones of the pelvis, often caused by accidents or falls. It can be life-threatening and requires immediate medical attention.

What Is a Pelvic Fracture?

A pelvic fracture is a break in one or more of the bones that make up the pelvis – the bony ring connecting the spine to the legs and protecting vital organs such as the bladder, intestines, and reproductive organs. The pelvis consists of the sacrum and two hip bones, each formed by the ilium, ischium, and pubis. Depending on the severity of the trauma, a pelvic fracture can range from a minor stress fracture to a life-threatening, unstable break with massive internal bleeding.

Causes

Pelvic fractures are typically caused by significant external forces or weakened bone structure:

High-energy trauma: Road traffic accidents, falls from heights, and industrial accidents are the most common causes in younger individuals.
Low-energy trauma: In older adults or those with osteoporosis, a simple fall from standing height can result in a pelvic fracture.
Stress fractures: Repetitive loading, common in endurance athletes, can lead to fatigue fractures of the pelvis.
Pathological fractures: Bone metastases or other bone diseases can weaken the pelvis to the point of spontaneous fracture.

Symptoms

Symptoms vary depending on the type and severity of the fracture:

Severe pain in the pelvic, groin, or hip area
Swelling and bruising around the pelvis or upper thigh
Reduced mobility in the hip and legs
Feeling of instability when standing or walking
Numbness or tingling in the legs (if nerves are affected)
Blood in the urine or difficulty urinating (if the bladder is injured)
Signs of shock such as pallor, rapid pulse, and altered consciousness (in cases of severe internal bleeding)

Diagnosis

Diagnosis of a pelvic fracture involves a combination of clinical examination and imaging studies:

Physical examination: The physician assesses tenderness, pelvic instability, and any neurological or vascular compromise.
X-ray: Initial imaging to identify obvious fractures and gross displacement.
Computed Tomography (CT): Gold standard for detailed assessment of fracture type, extent, and associated injuries.
Magnetic Resonance Imaging (MRI): Used additionally when soft tissue, nerve, or vascular injuries are suspected.
Angiography: Indicated when arterial bleeding within the pelvis is suspected.

Classification

Pelvic fractures are classified using various systems. A commonly used classification distinguishes:

Type A (stable): The pelvic ring is intact; no instability, e.g., avulsion or stress fractures.
Type B (rotationally unstable): Partial disruption of the pelvic ring with rotational instability.
Type C (rotationally and vertically unstable): Complete disruption of the pelvic ring with high risk of hemorrhage and organ injuries.

Treatment

Conservative Treatment

Stable fractures without displacement of bone fragments can often be managed conservatively with bed rest, pain management, physiotherapy, and gradual weight-bearing under medical supervision.

Surgical Treatment

Unstable or displaced fractures usually require surgical intervention:

External fixation: Temporary stabilization of the pelvic ring using an external frame, often used as an emergency measure.
Internal fixation (ORIF): Open reduction and internal fixation using plates, screws, or intramedullary nails for permanent stabilization.
Pelvic C-clamp: Emergency compression of the pelvis in cases of life-threatening hemorrhage.
Angioembolization: Catheter-based occlusion of bleeding vessels in cases of arterial hemorrhage.

Rehabilitation

After acute treatment, comprehensive rehabilitation is essential. Physiotherapy, gait training, and targeted strengthening exercises help restore mobility. Early mobilization is particularly important in elderly patients to prevent complications such as deep vein thrombosis or pneumonia.

Complications

Severe pelvic fractures can be associated with serious complications:

Life-threatening internal hemorrhage
Injuries to the bladder, urethra, bowel, or reproductive organs
Nerve damage leading to permanent paralysis or sensory deficits
Deep vein thrombosis and pulmonary embolism
Chronic pain and restricted movement
Malunion resulting in leg length discrepancy or gait disturbances

References

Tile M., Helfet D., Kellam J.: Fractures of the Pelvis and Acetabulum – Principles and Methods of Management. Thieme, 2003.
American College of Surgeons: Advanced Trauma Life Support (ATLS) Student Course Manual, 10th Edition. 2018.
World Health Organization (WHO): Falls and fracture prevention. Available at: https://www.who.int/news-room/fact-sheets/detail/falls (accessed 2024).

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