Related Subjects:
|Fractured Neck of Femur
|Fractured Shaft Femur
|Supracondylar Femur Fractures
|Supracondylar Humerus Fractures
|Femoral fractures
|Fractured Tibia and Fibula
|Pelvic fractures
Pelvic Fractures 🦴🚨 are high-risk injuries often associated with major trauma, haemorrhage, and multi-organ injury.
👉 Mortality ≈10% in closed fractures, up to 50% in open fractures.
Always consider associated injuries and hidden blood loss → involve the major trauma centre early.
📖 About
- Pelvis = bony ring formed by sacrum, SI joints, innominate bones, and pubic symphysis.
- Fractures usually occur in ≥2 places due to ring structure.
- Mechanism: high-energy trauma (RTA, fall from height, crush).
Low-energy fragility fractures in elderly/osteoporotic patients.
⚙️ Aetiology
- High force → RTA, falls, crush injuries.
- Low force → osteoporotic or pathological fractures.
- Structures at risk: bladder, urethra, vessels, rectum, uterus/vagina.
🩺 Clinical Features
- Shock from haemorrhage (may be hidden retroperitoneal).
- Severe pelvic/hip pain, bruising, swelling.
- Urethral injury signs: blood at meatus, high-riding prostate (on PR).
- PV/PR bleeding may indicate vaginal/rectal injury.
- Always assess for other trauma (head, chest, abdomen, spine).
🔎 Predictors of Major Haemorrhage
- Hct < 30% 📉
- HR > 130 bpm ❤️🔥
- Displaced obturator ring fracture
- Wide pubic symphyseal diastasis
📊 Tile Classification
| Type A | Stable: avulsion fractures, isolated pubic ramus, iliac wing fractures. Often low-energy, muscle avulsion (e.g. AIIS → rectus femoris, ASIS → sartorius, ischial tuberosity → hamstrings). |
| Type B | Rotationally unstable but vertically stable.
B1 = “open book” (AP compression).
B2 = ipsilateral compression (overriding pubic bones).
B3 = contralateral compression (pubic rami fracture one side + SI compression other side). |
| Type C | Rotationally + vertically unstable. Ring disrupted in ≥2 places. Massive blood loss, high mortality.
C1 unilateral, C2 bilateral, C3 with acetabular involvement. |
🧾 Simple Classification
- Stable: single break, minimal bleeding, bones remain aligned.
- Unstable: ≥2 breaks, moderate–severe bleeding, deformity.
⚠️ Complications
- Massive haemorrhage, intrapelvic compartment syndrome.
- Bladder, urethral, vaginal, rectal injuries.
- Venous thromboembolism.
- Sexual dysfunction, impotence.
- Chronic instability, deformity, pain.
- Infection/osteomyelitis (esp. open fractures).
🧪 Investigations
- Bloods: FBC, U&E, coagulation, group & crossmatch.
- Urinalysis (haematuria → bladder/urethral injury).
- X-ray: AP pelvis (trauma screen).
- CT: pelvic inlet/outlet, evaluate associated injuries.
- Retrograde urethrogram if urethral injury suspected.
- Angiography: for ongoing bleeding (>0.5 units/hr) → embolisation.
💊 Management
- Initial: ATLS protocol, balanced resuscitation, analgesia.
- Pelvic binder: apply if haemodynamic instability suspected → reduces pelvic volume, promotes clot formation. Keep on until definitive management.
- Do not roll in unstable B/C fractures → use straight lift with ≥4 helpers.
- Avoid urethral catheter if blood at meatus/high-riding prostate → consider suprapubic catheter.
- Open wounds: IV antibiotics, tetanus, urgent debridement. May need colostomy if bowel involved.
- Definitive:
- Type A: usually conservative → analgesia, rest, mobilisation with aids. Fixation if acetabulum involved.
- Type B/C: external fixation (pins + frame) or internal fixation (plates/screws). Consider angiography/embolisation if persistent bleeding.
📌 OSCE / Exam Pearls
- Pelvic fracture = assume massive blood loss until proven otherwise.
- Blood at urethral meatus 🚨 → do NOT catheterise → retrograde urethrogram first.
- Apply pelvic binder early in shocked trauma patient with pelvic injury suspicion.
- Stable vs unstable classification is high-yield in exams.
📚 References
- ATLS®: Advanced Trauma Life Support, 10th edition.
- BOAST Guidelines: Management of Pelvic Fractures.
- Rockwood & Green’s Fractures in Adults, 9th edition.
