Pelvic fractures: specialists and information

The pelvis consists of several firmly connected bones and forms the connection between the spine and the legs. A pelvic fracture is a fine crack that runs through one of the pelvic bones. It usually occurs as a result of falls or traffic accidents.

Further information and selected pelvic fracture specialists can be found below.

What is special about a pelvic fracture?

In pelvic fractures, a distinction is made between injuries to the pelvic ring and those to the hip socket (acetabulum). Depending on how stable the pelvic ring is, the fracture is either stable or unstable. Stable means that the bone holds relatively well on its own. Unstable means that the bone continues to shift without surgery, leading to incorrect healing and concomitant injuries.

If the accident victim is also injured in other parts of the body, this is referred to as a polytrauma. For example, 4 out of 10 injured people also suffer a craniocerebral trauma. Injuries to the abdominal organs occur in every fourth accident victim with a pelvic fracture.

What types of pelvic fractures are there?

If the pelvic bone has not broken through, it is an incomplete pelvic fracture. Only in rare cases does it break through completely. Then the doctor speaks of a complete pelvic fracture. A complete pelvic fracture is often life-threatening, as there are numerous large blood vessels in the abdomen. They can rupture even with slight pelvic movements, causing the patient to die from internal bleeding.

For this reason, pelvic fractures are also divided into stable and unstable. This reflects the fact that the pelvic bone surrounds the pelvic organs and in the case of an unstable fracture there is a risk that these will be injured by displaced pieces of bone.

What does the classification according to type A, B and C mean?

When classifying pelvic fractures into types A, B and C, stability is the decisive criterion.

Stable pelvic fracture

In a type A pelvic fracture, the pelvic ring is not damaged. There is no danger to the patient' s life, as only sacral and coccygeal fracturesare involved. They are transverse and often heal by themselves. This fracture can often be treated without surgery with painkillers and physical rest after initial bed rest.

Unstable pelvic fracture

In a type B pelvic fracture, the anterior and posterior pelvic rings are broken. The pelvis is only stable vertically, but not rotationally (all around). This is the case with a pubic bone fracture, for example. The two halves of the pubic bone - located at the very bottom of the pelvis - are then folded open like a book. Anyone with this "open book" is no longer able to walk. This type of fracture often requires surgical treatment; initially, the pelvic bone can be stabilized with an external scaffold (external fixator) to prevent further displacement and thus minimize the risk of injury to internal organs

Completely unstable pelvic fracture

In a type C pelvic fracture, the pelvic bones are unstable both vertically and circumferentially.

What is an acetabular fracture?

In an acetabular fracture, also known as an acetabular fracture, the hip socket is broken. The acetabulum is the bony curve in which the upper part of the thigh bone sits. The hip sockets are located on the right and left on the outside of the pelvis and are the center of the hip joint.

The anatomy of the hip and its bony parts © bilderzwerg / Fotolia

What are the causes of a pelvic fracture?

A pelvic fracture is caused by force acting on the pelvic bones, for example as a result of an accident or fall. How and to what extent the lower abdomen is damaged depends on the direction from which the force comes and how intense these forces are.

Forces acting on the pelvis from the side cause the pelvic ring to bend. If the force comes from the front, the pelvic blades move backwards. Force directed downwards from above moves the pelvic halves vertically against each other.

Older people with osteoporosis have an increased risk of suffering a pelvic fracture. The disease usually affects women over 60 and is the result of along-term calcium deficiency. This causes the bone substance to become brittle. In patients with osteoporosis, even a harmless fall can cause a complicated pelvic fracture.

How can you tell if you have a pelvic fracture?

A stable pelvic fracture generally causes less severe symptoms than an unstable fracture. The most common pelvic fracture symptoms include

• severe pain in the pelvic area
• Swelling in the hip region
• limited mobility of one leg
• Bruising at the site of injury
• Different leg lengths
• Feeling of instability in the pelvic area
• Misalignment of the pelvic bones
• Bloody urine due to bladder injury
• Strongly increased pulse
• Pale face
• restlessness
• confusion

How is a pelvic fracture diagnosed?

A pelvic fracture is diagnosed by a specialist in trauma surgery and orthopaedics. If the casualty is admitted to a hospital emergency room, the first step is to record the course of the accident.

This is followed by an examination of the injured person for physical damage:

• The trauma surgeon carefully feels the pelvic bones for palpable misalignments.
• Light pressure on the pelvic blade reveals whether the pelvic bones are stable or unstable.
• Palpation of the pubic symphysis - located between the two semicircular pubic bones - and an examination of the rectum help to determine whether the patient has abdominal bleeding.
• The examining specialist also checks the ability of both legs to move and feel. This is how he finds out whether he also has nerve damage.
• Checking the pulse provides information on whether the extremities are sufficiently supplied with blood.
• The pelvic X-ray image can be used to determine whether the pelvic fracture is stable or unstable. If the examiner is concerned that the posterior pelvic ring is also fractured, he will also have oblique images taken. In this way, for example, displaced parts of the pelvic bone can be precisely localized.
• Computed tomography (CT), another imaging procedure, is also a great help in this case: it allows conclusions to be drawn about the severity of the pelvic fracture. Soft tissue injuries and bruising can also be clearly seen on the CT scan.
• Blood leaking into the abdominal cavity can also be clearly seen on the ultrasound image.

Depending on what other injuries the pelvic fracture patient has, further examinations may follow:

• Urethrography to diagnose urethral ruptures,
• excretory urography to determine injuries to the urinary tract,
• angiography to localize the bleeding.

How is a pelvic fracture treated?

The treatment of a pelvic fracture depends on

• how severe the patient's injuries are and
• the general physical condition of the patient.

Type A pelvic fractures are treated conservatively:

• Bed rest for several days,
• administration of pain-relieving medication and
• physiotherapy (movement exercises).

Type B and type C pelvic fractures require emergency medical treatment and surgery. As the patient is suffering from severe blood loss, he must first be stabilized, i.e. the bleeding must be stopped. He is also given a lot of fluid intravenously to prevent him from collapsing.

The impaired pelvis is then stabilized with an anterior external fixator. This is a holding system consisting of metal parts that is attached to the bone from the outside via the skin and is intended to immobilize the fracture.

Alternatively, a pelvic clamp can also be used. This surgical emergency instrument has rods and plates and is always used if the patient could bleed to death. Pelvic clamps are usually only used in specialist clinics.

Acetabular fractures are always treated surgically to prevent premature wear of the joint. As the procedure is very difficult, it is preferably carried out in a specialist clinic. The trauma surgeon fixes the broken part of the joint with metal plates and screws or an external fixator.

How long does the healing process take for a pelvic fracture?

How quickly a pelvic fracture heals depends on various factors, including the type of fracture. Stable pelvic fractures, such as a coccyx fracture, usually heal quickly and without complications within 4 to 8 weeks, without leaving any late damage.

If the treatment of an unstable fracture (type B and C) is successful and there are no complications, the healing time is several months. Most patients can then lead a normal life again. However, permanent damage such as incontinence (involuntary loss of urine or stool) and male impotence(impaired sexual function) can sometimes occur.

The duration of recovery naturally also depends on individual factors such as the age and state of health of the accident victim.