• Clinical science

Pelvic fracture

Summary

Pelvic fractures most often occur in patients with multiple trauma caused by impact injuries such as car accidents or falls. Patients present with pelvic pain, reduced range of motion, and hematomas. Concomittant injuries such as urethral injury are common. The pelvic stability of every patient with multiple trauma must be checked, as shifted pelvic injuries tend to lead to extensive intraperitoneal and retroperitoneal bleeding, which can lead to hemorrhagic shock or death. The treatment for stable fractures is often conservative, with short-term bed rest and subsequent pain‑adapted mobilization. Unstable pelvic ring fractures with open fractures or significant bleeding require surgery for hemorrhage control, external fixation. This is followed by definitive fixation with plates or screws after the patient becomes hemodynamically stable. Alongside other possible complications, there is a significantly increased risk of thrombosis, and prophylaxis should be administered accordingly.

Epidemiology

References:[1][2][3]

Epidemiological data refers to the US, unless otherwise specified.

Etiology

  • High speed car and motorcycle accidents
  • Falls, especially in the elderly

References:[4]

Clinical features

An isolated unilateral anterior fracture of the pelvic ring may exhibit fairly mild symptoms!

References:[1][4][5][6][3][7]

Treatment

  • General
    • Adequate resuscitation and stabilization
    • Prompt pelvic stabilization with an external binder
  • Conservative treatment
  • Surgical treatment
    • Indication: open or unstable fractures, complications (e.g., urological injury), hemorrhage
    • Procedures
      • Emergency surgery in the case of massive bleeding: angiography with embolization of affected blood vessels, external fixation ., or pelvic C-clamp if needed
      • Definitive surgical treatment of the pelvic fracture and post-intensive care stabilization: stabilization and refixation of dislocated fragments, employing plates or screw external or internal fixation (for hemodynamically stable patients)
      • Rapid treatment of concomitant injuries (urinary tract, sphincter, intestinal injuries)

References:[1][8][9]

Complications

A pelvic injury always requires thrombosis prevention because of the high risk of thrombosis associated with it!

References:[6][9]

We list the most important complications. The selection is not exhaustive.