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Pelvic injuries are fortunately quite rare as the pelvis is protected by the pelvic bones and sacrum. Most pelvic injuries are directly related to fractures of the pelvic bones that disrupt internal pelvic structures, such as the uterus, prostate gland, and major vessels. Pelvic bones bleed profusely when fractured so the most common cause of death due to pelvic injuries is haemorrhage. Pelvic injuries usually result from falls from great heights or motor vehicle injuries and usually involve many more injuries than just a pelvic injury.
A pelvic fracture results from a disruption of the bony structures of the pelvis. Pelvic fractures can occur anywhere in the pelvis, from the front to the sides to the back of the pelvis, where the sacrum connects to the pelvic bones. Fractures involving the greatest morbidity and mortality are those that involve significant forces to the body, such as with a car crash or great fall.
The bony pelvis consists of the ilium, which makes up the iliac wings, the ischium and the pubis in the front of the pelvis. It forms a ring that requires a great degree of force in order to fracture it. Because of the great force, internal bleeding and disruption of internal organs are quite common. Trauma to the femur and other leg bones are also common secondary fractures to the pelvic fracture or fractures.
There are two classification systems for classifying pelvic fractures. The first is called the "Tile" system. It depends on the integrity of the sacroiliac complex. In type A injuries, the sacroiliac joint is intact and the pelvic ring is stable. In type B injuries, there are rotational forces that partially disrupt the sacroiliac joint. These are usually unstable fractures. In type C fractures, there is complete disruption of the SI joint and the fracture is unstable in both vertical and rotational ways. These are from severe trauma.
The Young classification syndrome is based on the mechanism of injury. Grade I injury is associated with sacral compression on the side of the impact. Grade II injuries are associated with posterior iliac fractures on the side of the impact. Grade III injuries are associated with contralateral sacroiliac joint injuries. Fortunately, elderly individuals can get only fractures of the pelvic rami, which are stable fractures that do not disrupt the ring.
Pelvic fractures represent 3 percent of all fractures of the bones and involve 1-2 percent of fractures seen in children. The most common types of pelvic fractures are single pubic rami fractures and avulsion fractures, both of which are extremely stable.
Half of all pelvic fractures are a result from a fall from a standing position or other incidence that is mild to moderate trauma. More severe fractures come from major traumatic events. Pelvic fractures are associated with greater mortality, in part because of the heavy bleeding that goes on and in part because of the damage to internal organs that bleed excessively. The rate of mortality is from 3 to 20 percent. For those younger than age 16 years, the mortality rate is around 5 percent, usually due to haemorrhage or perhaps multiple other injuries. Elderly patients have a worse mortality from pelvic trauma than younger people. They also get fractures more commonly than young people.
The diagnosis of pelvic trauma can be done via an x-ray of the pelvis, which should easily show a fracture. An MRI or CT scan of the pelvis can also show a pelvic fracture as well as any injuries to internal organs or areas of excessive bleeding. Doctors look for laxity or instability of the pelvis on palpation of the pelvic bones. Blood in the urine suggests possible pelvic fracture as is vaginal bleeding and instability on hip adduction or rotation of the hip joint itself.
Treatment of the pelvic injury involves treating any internal injury surgically. The pelvis, if not displaced, can be treated by rest and non-surgical pain control. If the pelvic injury is unstable, surgery is required in order to keep the bones together until they heal.
LAWYER HELPLINE: ☎ 1800 339 958The author of the substantive medical writing on this website is Dr. Christine Traxler MD whose biography can be read here