Pelvis Fracture

The adequate treatment of pelvic fractures-luxations for each patient is not only related to the degree of injury and ligament or bone dislocation, but also to the presence of lesions in the extremities, head, thorax or abdomen. The orthopaedic specialist must be present at the initial resuscitation of the patient and be included in the decision-making process. The first priority is to save the patient's life and this depends on a complete understanding of the possible lesions, the possibility of continued blood loss, and the associated pelvic and systemic lesions.

The fundamental principles of treatment are:

• Early and aggressive treatment with appropriate resuscitation.
• Immediate surgical debridement of open wounds.
• Stabilization of pelvic fractures.
• Thoracotomy, laparotomy and even emergency colostomy, if necessary.

In young adults, severe fractures affecting the entire pelvis can occur as a result of high-speed car or motorcycle accidents, a collision between a car and a pedestrian, or falls from a certain height. These fractures can cause life-threatening bleeding, whether or not the skin breaks. They can cause a dangerous drop in blood pressure (shock). Nerves and nearby organs, such as the bladder, reproductive organs, and bowel, can also be injured. Severe fractures are often unstable.

In some older people, osteoporosis weakens the bones. Therefore, they may suffer a fracture of the pelvis if they fall, for example, out of the bathtub, down stairs, or even while standing on flat ground.

One type of pelvic fracture tends to occur mostly in teenagers, especially those who participate in sports activities. These fractures (called avulsion fractures) usually occur when a muscle suddenly contracts and tears a small piece of bone from the ischium, where the ischiotibial muscles are inserted (at the bottom of the buttock).

If a person believes that his or her pelvis has been fractured, he or she should immediately go to an emergency department. If the injury occurred in the context of a serious accident, the subject is usually taken by ambulance to an emergency department. There, injuries are identified and treatment begins.

The physician suspects a pelvic fracture when the patient has groin pain or has suffered severe trauma. X-rays are then taken. X-rays can show most pelvic fractures. A computed tomography (CT scan) is usually done to identify all broken bone fragments and to detect other possible injuries.

To check for other lesions (particularly of the urinary tract see Introduction to lesions of the urinary tract and genitals), doctors perform a scan. This includes a neurological examination (see Neurological Examination), a rectal examination, and, in women, a gynaecological examination. Urinalysis is also done. If the doctor suspects injury to the urinary tract, a CT scan or other imaging test of the urinary tract is done.