Pelvic Fractures

Pelvic fractures¹‚²‚³ involve the bones that form the pelvic ring: hip bones, sacrum, and coccyx. These fractures are uncommon and only account for about 3% of fractures in adults, more common in males under age 35 and females over the age of 35.2 These fractures are more common in the elderly population, especially those suffering from weaker bones such as from diseases like osteoporosis.

To understand these fractures, we need to know the anatomy of the pelvis, which comprises the sacrum (base of the spine), coccyx (tailbone), and hip bones. The ilium, ischium, and pubis start as separate structures at birth and fuse over time to create the acetabulum (the hip joint socket).3 Ligaments hold the pelvis and sacrum together in a bowl shape. The pelvis protects significant nerves, blood vessels, parts of the bowel, and the reproductive organs from injury. The hip, thigh, and abdomen muscles are also anchored here.

Causes

Due to the stability of the pelvic bones, fractures to this area usually involve a high-impact trauma or weakness to the structure of the bones. Athletic injuries lead to avulsion fractures. Pathologic fractures occur in 5% of hip fractures due to disease.1 The most common causes of pelvic fractures include:

Vehicular collision
Fall from a significant height
Osteoporosis

An avulsion fracture is caused by the hamstring muscle being torn from its attachment to the bone

Symptoms

If you are unable to put weight on your leg due to pain and you have experienced a traumatic injury, it is essential to visit a qualified orthopedic specialist. A proper diagnosis can prevent further injury and allow for the best outcome. The most common symptoms of a pelvic fracture include:

Pain is worse with movement of the hip or ambulation
Swelling or bruising in the area

Diagnosing

Because pelvic fractures are often from high-impact trauma, most patients will have multiple injuries and end up in the emergency room via ambulance ride. The diagnostic process begins with a physical examination and medical history. CT scans are the definitive diagnostic imaging test to diagnose pelvic fractures. X-rays are also effective and are often the first line of diagnostic imaging following an injury. MRIs are less common but can show fractures not visible on X-ray or CT imaging.

Treatments

Treatment of a pelvic fracture depends on whether the fracture is stable and if there are other injuries from the trauma.

Conservative Treatment Options

For stable fractures, conservative treatment may be recommended. This is usually in the form of activity modification and using devices such as a walker or wheelchair to aid in ambulation until the fracture heals. This can take up to 3 months or longer.3

Surgical Treatment

Unstable fractures and those with multiple injuries often require surgical treatment.

External fixation: Metal pins or screws through the skin into the bone to hold the fracture in place. This can be the only treatment or a temporary solution until the patient is stable enough for another form of fixation.
Skeletal traction: Weights and counterweights in a pully system designed to pull bones into proper alignment. This is usually done immediately following the trauma and is temporary until the patient can undergo surgical fixation.
Open reduction and internal fixation (ORIF): Bones are held in alignment with plates and screws attached to the outside of the bone.

Complications

All surgical procedures come with risks: pain, bleeding, nerve damage, and wound problems. Your orthopedic surgeon will discuss risks and possible complications before surgery. Complications following surgical fixation can include hardware loosening or breaking and require replacement. Pelvic fractures also have a risk of medical complications, including pulmonary embolism (blood clot in the lung) or other blood clots.

References:

Emmerson BR, Varacallo M, Inman D. Hip Fracture Overview. PubMed. Published 2020. https://www.ncbi.nlm.nih.gov/books/NBK557514/
Gage, MD M, Dunbar, MD RP, Lowe, MD JA. Pelvic Fractures. OrthoInfo. Published May 2023. https://orthoinfo.aaos.org/en/diseases–conditions/pelvic-fractures/
Davis DD, Foris LA, Kane SM, Waseem M. Pelvic Fracture. PubMed. Published 2020. https://www.ncbi.nlm.nih.gov/books/NBK430734/