The pelvis is the foundation of the body. It is the pelvis that serves as the floor for the abdominal cavity. It is the “basin” in which lie the reproductive organs, vital visceral structures such as the bowel and bladder, and large blood vessels and nerves that connect the body to the legs. Another name for the pelvis in French is “le bassin.”
The pelvis forms a ring, comprised of three bones: the sacrum, and the right and left innominate bones. The ring like structure serves as the connection of the hip joints to the lumbar spine.
Injuries to the pelvic ring generally fall into two categories, High and low energy pelvic ring injures.
High energy injures generally are those that are generated in a fall from height, high speed motor vehicle crashes, bicycle or motorcycle crashes, skiing and snowboarding injures.
Understandably, high energy injuries that disrupt the pelvic ring can be life threatening as these vital organs and structures can get torn as the ring is fractured by high energy forces. These injuries commonly need urgent attention to stabilize.
Lower energy injuries commonly fall into two categories:
- Avulsion injuries in the young athlete population
- Insufficiency fractures in the elderly
Avulsion injuries of the pelvis commonly occur during forceful contraction of muscles that attach to the pelvis. An avulsion occurs when the force is sufficient enough to pull the muscular attachment off of the pelvis with a piece of bone. The hamstring muscles and the rectus femoris muscles are the most common muscles that sustain these injures.
The elderly population with osteoporosis. An individual may fracture the pelvis during a fall from standing, such as when getting out of the bathtub or descending stairs. These injuries usually do not destabilize the pelvic ring but may impart varying degrees of deformity to the pelvis.
Pelvic fractures can be described and classified in a variety of ways. Usually x-rays and/or a CT scan is required to define the injured structures and assess the need for subsequent intervention.
Many stable fractures, such as the avulsion fracture experienced by an athlete will commonly heal without surgery. While much has been written on the subject there is little consensus as to the requirement for surgery for these injuries. The patient will have to use crutches or a walker, and will not be able to put all of his or her weight on one or both legs for up to three months, or when the bones are healed. The doctor may prescribe medication to lessen pain. Because mobility may be limited for several months, the physician may also prescribe a blood-thinner to reduce the risk of blood clots forming in the veins of the legs.
Surgical Treatment of Pelvic Fractures
Pelvic fractures that result from high-energy trauma are often life-threatening injuries because of the extensive bleeding. In these cases, doctors may use an external fixator to stabilize the pelvic area. This device has long screws that are inserted into the bones on each side and connected to a frame outside the body. The external fixator allows surgeons to address the internal injuries to organs, blood vessels and nerves.
What happens next depends on the type of fracture and the patient’s condition. Each case must be assessed individually, particularly with unstable fractures. Some pelvic fractures may require traction. In other cases, an external fixator may be sufficient. Many fractures may require surgical insertion of plates or screws.
If injuries are addressed, fractures usually heal well
Stable pelvic fractures heal well. Pelvic fractures sustained during a high-energy incident, such as an automobile accident, may have significant complications, including severe bleeding, internal organ damage, and infection. The long term result of pelvic fractures has more to do with the presence of these associated injures rather than the injury itself. Though an inadequately treated pelvic ring fracture can leave to long term sequellae such as chronic pain, limb length inequality or seating imbalance.
If these injuries are addressed, the fracture usually heals well. People may walk with a limp for several months because of damage to the muscles around the pelvis. Thse muscles take a long time to become strong again. Subsequent problems, such as pain, impaired mobility, and sexual dysfunction, are usually the result of damage to nerves and organs that is associated with the pelvic fracture.