Pelvic Fracture

A pelvis fracture is a break of any part of the pelvis. The pelvis consists of the two Ilia (Ilium - plural) - the large wing shaped bones, the Pubis and the Ischium which connect them at the front and the Sacrum which connects them at the back.

The pelvis is a very sturdy structure and so it requires a large force to fracture it. The exception is in the elderly who may suffer from osteoporosis. This means the bonse are weaker and may fracture more easily. Avulsion fractures of the pelvis are possible in athletes. This is where a muscle pulls away a small section of bone.

Pelvic fractures most frequently occur from a high energy impact such as a car or motorbike accident or a fall from a great height.

Due to the number of internal organs which are located within the pelvis, associated injuries to these organs and internal bleeding are not uncommon and so a thorough examination should be undertaken when a pelvic fracture is suspected.

Pelvic fractures can be classified by severity and the degree of stability present:

Grade A: Stable fracture - usually relatively minor fractures, including avulsion fractures such a Rectus Femoris avulsion, and fractures of one of the Ilia.

Grade B: Rotationally unstable - compression fractures, often with separation of the pubic symphesis and widening of the SI joints.

Grade C: Vertically and rotationally unstable - pelvis ring is completely disrupted. These injuries are extrememly severe, often with multiple complications and a high fatality rate.

Symptoms of a Pelvic Fracture

Symptoms of a fractured pelvis will vary greatly depending on the severity or type of fracture and any complications involved. A minor avulsion fracture may feel similar to a pulled muscle, but will feel directly on the bone and may demonstrate minor bruising.

Symptoms of more substantial fractures may include:

• Instant pain, usually on impact.
• Bruising and swelling develops within 48 hours (usually much quicker).
• Pain on moving - especially the hip.
• The patient may hold the leg a certain way to make it more comfortable.
• Numbness, tingling or cold, pale skin anywhere in the legs may indicate nerve or blood vessel damage.
• Grade C injuries often result in internal bleeding and so symptoms of shock such as nausea, light-headedness, a racing pulse, cold, clammy skin and loss of consciousness may occur.

Treatment

Treatment of a fractured pelvis varies depending on the severity:

Grade A injuries often just require rest, with initial non-weight bearing, being replaced by partial weight bearing using crutches within two weeks. This may have to continue for up to 3 months, until the bones are fully healed. Avulsion fractures usually heal much quicker than this. Your Doctor may prescribe pain killers or anti-inflammatory medication.

Grade B injuries may or may not require surgery, depending on their severity. If surgery is undertaken, this may involve externally fixing the two parts of bone, often with a cage on the outside of the body. This remains in place until the bones are healed. Your Doctor may prescribe pain killers, anti-inflammatory medication and even blood thinners as you will be immobile for some time.

Grade C injuries may not be the priority of treatment if extensive internal damage has occured. It may be more important to treat this first and stabilise the patient, before fixing the fracture site(s).

All forms of pelvic fracture should be treated with a rehabilitation programme to regain full movement and strength. This may begin quite early in the treatment process for minor injuries, with simple exercises such as contracting muscles and moving the legs.A Physiotherapist or Physical Therapist will usually advise you on this and demonstrate appropriate exercises.