Pelvic Fracture

Aetiology

• High energy injuries in the young - typically RTA or fall from height

• Frailty fractures of older osteoporotic bone

Pathophysiology

• Bony ring disruption usually affects more than one site, so they are usually multiple (either bones or symphysis/SI joints)
• Joints more likely to be affected in high energy injuries

• Young-Burgess classification is used to classify pelvic ring fractures

Clinical presentation

• Pain and inability to bear weight

Investigations

High energy

• If pelvis is the only site of injury → x-ray first

• In polytraumatic patients → CT first

• CT can also provide details of fractures already shown by x-ray

Low energy

• These fractures are often undisplaced, with normal x-rays

• CT is more sensitive than x-ray, especially when fractures start to heal

• MRI is the most sensitive - test of choice

Management

• Initial management for high energy mechanisms - pelvic binder (controls circulatory loss)

• Conservative - analgesia, weight bearing as tolerated

• Operative - ORIF, external fixators, internal fixators