The pelvis consists of three bones: ilium, ischium and pubis, and is joined to the sacrum at the bottom of the spine. The pelvis creates a cavity for protection of major blood vessels, major nerves, portions of the bowel, bladder and reproductive organs. A fracture can range from a hairline crack through to complete displacement of the bone or fractures in multiple pieces. Fractures to the pelvis refer to breaks in the bones of the pelvis. Major pelvic fractures are uncommon, although minor pelvic fractures in elderly or osteoporotic patients are more frequent.
Major pelvic fractures are generally the result of a traumatic injury
- Car or motorbike accidents
- Crush injuries
Conditions that weaken the bone such as osteoporosis may increase the risk of fracture on injury.
Fractures of the pelvis include:
- Unable to weight bear
- Swelling or bruising
- Point tenderness
- Problems related to damage to the internal organs, nerves or vessels that are normally protected by the pelvis
If you are experiencing any of the symptoms above following an injury, you should see your doctor or present to the emergency department.
Your doctor will discuss your symptoms and nature of the injury and conduct a physical examination. Your doctor will refer you for an x-ray to view the affected bones. A CT (computed tomography) scan will often to be useful to better appreciate the fracture. An MRI (magnetic resonance image) scan will rarely be required to identify injury to other surrounding structures. These fractures can be associated with damage to the nerves and vessels of the leg as well as internal organs such as the bladder or bowel. If this is the case further investigations may be required.
Initial treatment of pelvic injuries will often include treatment of any other life threatening issues such as bleeding or damage to internal organs.
If the bones are not displaced, your doctor may recommend non-surgical treatments such as walking aids to limit weight bearing and medications to relive pain and reduce the risk of blood clots.
Bones that are displaced will often require surgical procedures. These include:
- External fixation – pins are inserted into the bone and fixed on the outside of the skin with interconnecting rods
- Skeletal traction – is a pulley system of weights and counterweights that provide tension on the bones to assist alignment
- Open reduction and internal fixation – metal plates and screws are attached to the bones to hold them together
Pelvic fractures take many weeks to heal, and patients can expect to have limited mobility for at least 3 months. Full recovery will often take 6 months, and sometimes up to 12 months depending on the severity of the injury. Physiotherapy will usually be prescribed. Due to the high risk of blood clots after pelvic fractures blood thinning injections are usually prescribed for 4-6 weeks also.
- Malunion (bones heal in an abnormal position)
- Post traumatic arthritis
- Leg length inequality
- Damage to nerves or blood vessels
- Blood clots in legs or lungs
- Nonunion – non-healing of the bone.
Factors increasing the risk of nonunion include: