Pelvic Fracture
The pelvis is the sturdy ring of bones located at the base of the spine. Fractures of the pelvis are uncommon—accounting for only about 3% of all adult fractures.
Most pelvic fractures are caused by some type of traumatic, high-energy event, such as a car collision. Because the pelvis is in proximity to major blood vessels and organs, pelvic fractures may cause extensive bleeding and other injuries that require urgent treatment.
In some cases, a lower-impact event—such as a minor fall—may be enough to cause a pelvic fracture in an older person who has weaker bones.
Treatment for a pelvic fracture varies depending on the severity of the injury. While lower-energy fractures can often be managed with conservative care, treatment for high-energy pelvic fractures usually involves surgery to reconstruct the pelvis and restore stability so that patients can resume their daily activities.
The pelvis is a ring of bones located at the lower end of the trunk—between the spine and the legs. The pelvic bones include the:
- Sacrum (the large triangular bone at the base of the spine)
- Coccyx (tailbone)
- Hip bones
Because the pelvis is a ring-like structure, a fracture in one part of the structure is often accompanied by a fracture or damage to ligaments at another point in the structure. Doctors have identified several common pelvic fracture patterns. The specific pattern of the fracture depends upon the direction in which it was broken and the amount of force that caused the injury.
Stable fracture. In this type of fracture, there is often only one break in the pelvic ring and the broken ends of the bones line up adequately. Low-energy fractures are often stable fractures.
Unstable fracture. In this type of fracture, there are usually two or more breaks in the pelvic ring and the ends of the broken bones do not line up correctly (displacement). This type of fracture is more likely to occur due to a high-energy event.
High-Energy Trauma
A pelvic fracture may result from a high-energy force, such as that generated during a:
- Car or motorcycle collision
- Crush accident
- Fall from a significant height (such as a ladder)
Depending on the direction and magnitude of the force, these injuries can be life-threatening and require surgical treatment.
Bone Insufficiency
A pelvic fracture may also occur due to weak or insufficient bone. This is most common in older people whose bones have become weakened by osteoporosis. In these patients, a fracture may occur even during a fall from standing or a routine activity such as getting out of the bathtub or descending stairs. These injuries are typically stable fractures that do not damage the structural integrity of the pelvic ring, but may fracture an individual bone.
Treatment of pelvic fracture
External fixation. Your doctor may use external fixation to stabilize your pelvic area. In this operation, metal pins or screws are inserted into the bones through small incisions into the skin and muscle. The pins and screws project out of the skin on both sides of the pelvis where they are attached to carbon fiber bars outside the skin. The external fixator acts as a stabilizing frame to hold the broken bones in proper position.
In some cases, an external fixator is used to stabilize the bones until healing is complete. In patients who are unable to tolerate a lengthy, more complicated procedure, an external fixator may be used as a temporary treatment until another procedure can be performed.
Skeletal traction. Skeletal traction is a pulley system of weights and counterweights that helps realign the pieces of bone. Skeletal traction is often used immediately after an injury and removed after surgery. Occasionally, acetabular fractures can be treated with skeletal traction alone. This is rare, however, and will be a decision made jointly with input from your doctor.
