A pelvic fracture is a break in one or more bones of the pelvis.
Description
The pelvis is a butterfly-shaped group of bones located at the base of the spine. The pelvis consists of the pubis, ilium, and ischium bones (among others) held together by tough ligaments. With a cavity in its center, the pelvis forms one major ring and two smaller rings of bone that support and protect internal organs such as the bladder, intestines, and rectum. In women, the pelvis also surrounds the uterus and vagina. The pelvis is wider and has a larger cavity in females than in males because it must accommodate childbirth.
Fractures of the pelvis are uncommon, accounting for only 0.3–6% of all fractures. Pelvic rings often break in more than one place. Pelvic fractures range widely in severity. Disruption of the major ring is usually a severe injury while disruption of a minor ring is often not serious. A mild fracture (for example, one that occurs due to the impact of jogging) may heal in several weeks without surgery. However, a serious pelvic fracture can be a life-threatening event requiring emergency medical care and lengthy rehabilitation. The latter type of injury may involve damage to nearby internal organs.
Pelvic fractures are classified as stable or unstable, and as open or closed. A stable fracture is one in which the pelvis remains stable and involves one break-point in the pelvic ring with minimal hemorrhage. An unstable fracture is one in which the pelvis is unstable with two or more break-points in the pelvic ring with moderate to severe hemorrhage. All types of pelvic fractures are further divided into 'open' or 'closed,' depending on whether open skin wounds are present or not in the lower abdomen.
Causes and symptoms
Most pelvic fractures occur during high-speed accidents (such as car or motorcycle crashes) or falls from great heights. The greater the force, the greater the opportunity for a severe fracture. Pelvic fractures can also occur spontaneously or after minor falls in people with bone-weakening diseases such as osteoporosis. Less commonly, pelvic fractures may occur during athletic activities such as football, hockey, skiing, and long-distance running.
The primary symptom of a pelvic fracture is pain in the groin, hip, or lower back, which may worsen when walking or moving the legs. Other symptoms may include abdominal pain; numbness/tingling in the groin or legs; bleeding from the vagina, urethra (urine tube), or rectum; difficulty urinating; and difficulty walking or standing. A stress fracture that occurs while jogging may cause pain in the thigh or buttock.
Diagnosis
A pelvic fracture is typically diagnosed by an emergency physician looking for bone tenderness, limitations of movement, difficulty walking, and any loss of nerve function in the lower part of the body. In addition, the physician looks for signs of injury to nearby organs of the intestinal or genitourinary systems. This search may include checking the rectum, vagina, and urethra for signs of bleeding. The physician will order a plain x ray of the pelvis; this will usually detect the presence of a fracture. Blood and urine tests may also be done. A computed tomography (CT) scan will be performed in complicated cases. Depending on the severity of the fracture, other imaging procedures may be required as well, such as contrasting studies involving the injection of a radioactive dye; the pictures can be used to evaluate organs and structures in the pelvic area, such as the urethra, bladder, and blood vessels.
Treatment
In the case of a potentially serious pelvic fracture (such as that occurring after an accident or high fall), emergency assistance should be summoned. The person with the injury should be covered with a blanket or jacket (to maintain body heat), and should not be moved by non-trained personnel, especially if there is severe pain or signs of possible nerve injury.
Treatment depends on the severity of the injury. In the case of a minor fracture, treatment may consist of bed rest and over-the-counter (OTC) or prescription pain killers. Physical therapy, the use of crutches, and surgery may also be recommended. Healing can take anywhere from a few weeks to several months.
Severe injuries to the pelvis (such as those involving more than one break) can be life threatening, resulting in shock, extensive internal bleeding, and damage to internal organs. In these situations, the immediate goal is to control the bleeding and stabilize the injured person's condition. Resuscitation procedures may be required as well as large amounts of intravenous fluids and blood transfusions if internal bleeding is present. These injuries often require extensive surgery as well as lengthy rehabilitation.
Alternative treatment
To speed up the healing process, some practitioners of alternative medicine recommend magnetic field therapy, hydrogen peroxide therapy, calcium, vitamin D, vitamin B complex, and zinc.
Prognosis
The prognosis for minor pelvic fractures is excellent, with most people gaining full mobility in a matter of weeks or months. Severe pelvic fractures can be fatal due to internal bleeding or damage to nearby organs, or result in chronic pain and physical disabilities.
Prevention
People with bone-weakening conditions such as osteoporosis or cancer, or tendencies to fall are more vulnerable to bone fractures. They should follow their treatment regimens and make use of canes and other walking aids as well as safety devices in the home (bars, non skidding mats) and avoid climbing up, even on a small stool.
BOOKS
Dee, Roger, et al. Principles of Orthopaedic Practice New York: McGraw-Hill, 1997.
PERIODICALS
Brenneman, F. D., et al. "Long-term outcomes in open pelvic fractures." The Journal of Trauma (May 1997): 773-7.
Korovessis, P., et al. "Medium- and long-term results of open reduction and internal fixation for unstable pelvic ring fractures." Orthopedics (November 2000): 1165-71.
Malavaud, B., et al. "Evaluation of male sexual function after pelvic trauma by the International Index of Erectile Function." Urology (June 2000): 842-6.
ORGANIZATIONS
American Academy of Orthopaedic Surgeons. 6300 North River Road, Rosemont, IL 60018-4262. (800) 346-AAOS. <http://www.aaos.org>.
Greg Annussek
KEY TERMS
Fracture—A break in a bone.
Computed tomography (CT) scan—An imaging procedure that produces a series of thin x-ray slices of internal body organs or structures.
Osteoporosis—A decrease in the amount of bone mass, leading to fractures.
Shock—A condition of profound physiological disturbance characterized by failure of the circulatory system to maintain adequate blood supply to vital organs.
Stress fracture—A crack in a bone (usually the result of overuse).
