Pelvic Fracture
Basics
Description
Description
- 3% of all bony fractures
- Pelvis is made up of sacrum and 2 innominate bones:
- The innominate bones consist of the ilium, ischium, and pubis
- Boney structures are stabilized by a network of ligaments, musculature, and other soft tissues in the pelvic area
- Anterior stability and support are provided by the symphysis pubis and pubic rami
- Posterior stability and support are provided by the sacroiliac (SI) complex and pelvic floor
- Pelvis provides protection for lower urinary tract; GI tract; gynecologic, and vascular, and nervous structures contained in the region:
- Pelvic fractures have a high associated morbidity and mortality rate and require urgent diagnosis and therapy
- Unstable pelvic fractures are high risk for associated injuries including:
- Pelvic hemorrhage and hemorrhagic shock
- Intra-abdominal and GI tract injuries
- Genitourinary and urinary tract injuries
- Uterine and vaginal injuries
- Neurologic injuries
- Arterial and venous plexus injuries
Etiology
Etiology
- 65% of pelvic fractures are caused by vehicular trauma, including pedestrians struck by automobiles
- 10% caused by falls
- 10% caused by crush injuries
- The remainder caused by athletic, penetrating, or nontraumatic injuries
- Mortality rate from pelvic fractures is 6–19%:
- Increases with open fractures or evidence of hemorrhagic shock
- Significant hemorrhage can occur in unstable, high-energy pelvic fractures (Tile type B and C fractures):
- Bleeding most common with posterior injuries involving the vascular plexuses
- Retroperitoneal hematoma may tamponade in the enclosed pelvic space
Tile Classification System
- Includes stable single bone and avulsion fractures as well as pelvic ring fractures
- Predicts need for operative repair
- Type A: Stable pelvic ring injuries:
- A1: Avulsion fractures of the innominate bone (ischial tuberosity, iliac crest)
- A2-1: Iliac wing fractures
- A2-2: Isolated rami fractures; most common pelvic fracture
- A2-3: 4-pillar anterior ring injuries
- A3: Transverse fractures of sacrum or coccyx
- Type B: Partially stable pelvic ring injury (rotationally unstable, but vertically stable):
- B1: Unilateral open-book fracture
- B2: Lateral compression injury:
- B2-1: Ipsilateral double rami fractures and posterior injury
- B2-2: Contralateral double rami fractures and posterior injury (bucket-handle fracture)
- B3: Bilateral type B injuries
- Type C: Unstable pelvic ring injury – rotationally and vertically unstable, Malgaigne fracture:
- Anterior disruption of symphysis pubis or 2–4 pubic rami with posterior displacement and instability through sacrum, SI joint, or ileum:
- C1: Unilateral vertical shear fracture
- C2: Unilateral vertical shear combined with contralateral type B injury
- C3: Bilateral vertical shear fracture
- Anterior disruption of symphysis pubis or 2–4 pubic rami with posterior displacement and instability through sacrum, SI joint, or ileum:
- Acetabular fractures (posterior lip, central/transverse, anterior column, or posterior column fractures)
Young Classification System
- Based on mechanism of injury
- Only fractures that result in disruption of pelvic ring included; no single bone, avulsion, or acetabular fractures
- Predicts chance of associated injuries and mortality risk:
- LC: Lateral compression
- APC: Anteroposterior compression
- VS: Vertical shear
- CM: Combination of injury patterns
Pediatric Considerations
- Children can have greater hemorrhage
- Nonaccidental trauma is a concern
Pregnancy Considerations
Gravid uterus may be at risk for injury, including uterine rupture
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Citation
Schaider, Jeffrey J., et al., editors. "Pelvic Fracture." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307448/all/Pelvic_Fracture.
Pelvic Fracture. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307448/all/Pelvic_Fracture. Accessed December 7, 2024.
Pelvic Fracture. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307448/all/Pelvic_Fracture
Pelvic Fracture [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 December 07]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307448/all/Pelvic_Fracture.
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