Pelvic Fracture

• young: high energy trauma, either direct or by force transmitted longitudinally through the femur
• elderly: fall from standing height. low energy trauma

Clinical Features

• local swelling. tenderness
• deformity of lower extremity
• pelvic instability

Investigations

• x-ray: AP pelvis, inlet and outlet for pelvic fracture

o       Judet films (obturator and iliac oblique) for acetabular fracture

o       6 cardinal radiographic Unes of the acetabulum: ilioischial line, iliopectlneal line, teardrop. roof, posterior rim. anterior rim

• CT scan useful for evaluating posterior pelvic injury and acetabular fracture

 Table 4. Tile Classification of Pelvic Fractures (see Figure 11)

Type: Stability Description

A Rotationally stable Vertically stable

A1: fracture not involving pelvic ring

A2: minimally displaced fracture of pelvic ring {e.g. ramus fracture)

B Rotationally unstable Vertically stable

B1: open book

B2: lateral compression- ipsilateral

B3: lateral compression- contralateral

c Rotationally unstable

C1: unilateral Vertically unstable

C2: bilateral

C3: associated acetabular fracture

Treatment

• ABCs
• assess genitourinary injury (rectal exam, vaginal exam, hematuria, blood at urethral meatus)

o       if involved, the fracture is considered an open fracture

• stable fractures - nonoperative treatment, protected weight-bearing
• indications for operative treatment

o       unstable pelvic ring injury

o       disruption of anterior and posterior SI ligament

o       symphysis diastasis >2.5 cm

o       vertical instability of the posterior pelvis

 Specific Complications (see General Fracture Complications)

• hemorrhage (life-threatening) - 1500-3000 ml blood loss
• injury to rectum or urogenital structures
• obstetrical difficulties
• persistent sacroiliac (SI) joint pain
• post-traumatic arthritis of the hip with acetabular fractures
• high risk of DVT/PE