Overview

The pelvis is the foundation of the body. The pelvis serves as the floor for the abdominal cavity and the “basin” that holds the reproductive organs, vital visceral structures such as the bowel and bladder, large blood vessels, and nerves that connect the body to the legs. The pelvis forms a ring comprised of three bones: the sacrum, and the right and left innominate bones. The ring-like structure serves as the connection of the hip joints to the lumbar spine.
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Injuries to the pelvic ring generally fall into two categories, high and low energy pelvic ring injuries. High energy injuries commonly occur after a fall from a ladder, motor vehicle crashes, bicycle or motorcycle crashes, skiing and snowboarding injuries. High-energy injuries that disrupt the pelvic ring can be life-threatening if vital organs and structures are also injured when the pelvic ring is fractured. These injuries commonly need urgent attention at a trauma center to stabilize.

Lower energy injuries commonly fall into two categories:

• Avulsion injuries in the young athlete population
• Osteoporotic (insufficiency) fractures in the elderly population 

Avulsion injuries of the pelvis commonly occur during forceful muscle contraction that pulls off a piece of the pelvis. The hamstring and the rectus femoris muscles are the most common muscles that create these injures.

Osteoporotic or insufficiency fractures pelvis fractures occur after a low-energy incident. An individual may fracture the pelvis during a fall from standing, such as when getting out of the bathtub or descending stairs. These injuries usually do not destabilize the pelvic ring but may impart varying degrees of deformity to the pelvis. X-rays and a CT scan are used to define the injured structures and assess the potential recommendation for surgery.

Many stable fractures, such as the avulsion fracture experienced by an athlete or a minimally displaced osteoporotic fracture will commonly heal without surgery. The patient will sometimes have to use crutches or a walker, and may not be able to put all body weight on one or both legs for a period of time. Because mobility may be limited for several months, the physician may also prescribe a blood-thinner to reduce the risk of blood clots forming in the veins of the legs.

Pelvic fractures that result from high-energy trauma are often life-threatening injuries because of the extensive bleeding. In these cases, doctors may use an external fixator to stabilize the pelvic area. This device has long screws that are inserted into the bones on each side and connected to a frame outside the body. The external fixator allows surgeons to address the internal injuries to organs, blood vessels and nerves. 

Each case must be assessed individually based on the type of fracture (i.e. unstable fractures) and the patient’s condition. Some pelvic fractures may require traction. In other cases, an external fixator may be sufficient. Many fractures may require surgical insertion of plates or screws.

Stable pelvic fractures heal well. Pelvic fractures sustained during a high energy incident such as an automobile accident may have significant complications, including severe bleeding, internal organ damage, and infection. The long term result of pelvic fractures has more to do with the presence of these associated injures rather than the injury itself. An inadequately treated pelvic ring fracture can lead to a long term secondary condition such as chronic pain, limb length inequality or seating imbalance.

If these injuries are addressed, the fracture usually heals well. People may walk with a limp for several months because of damage to the muscles around the pelvis. These muscles take a long time to become strong again. Subsequent problems, such as pain, impaired mobility, and sexual dysfunction are usually the result of damage to nerves and organs that is associated with the pelvic fracture.