Pelvic Fracture is a topic covered in the 5-Minute Emergency Consult.

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Basics

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

  • 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)
      • B2-3: 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
  • 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

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TY - ELEC T1 - Pelvic Fracture ID - 307448 Y1 - 2016 PB - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307448/all/Pelvic_Fracture ER -