Emergency Management of Pelvic Fractures

Introduction

A fracture is a complete or partial break in the continuity of the bone. The bone can fracture lengthwise or crosswise at many places or into many pieces. The major reason for a fracture is when the bone is impacted by pressure or force more than it can bear. Common causes of fractures include falling or trauma like a car accident, sports injury, etc. Most fractures are accompanied by intense pain, swelling, redness, and bruising of the affected area. Sometimes a sound is heard when the bone breaks. Sometimes, even a small injury is enough to cause a pelvic fracture, especially in older patients.

What Are the Types of Fractures?

• Simple or Closed Fractures: When the broken bone does not tear the skin, it is called a closed or a simple fracture.

• Compound or Open fracture: When the bone tears the skin and exposes the tissue, it is said to be an open or compound fracture. The risk of infection is increased in this case.

• Complete Fracture: When the bone breaks into two or more pieces. It is said to be a complete fracture.

• Partial Fractures: When the fracture does not go through the bone, it is said to be a partial fracture.

• Stress Fracture: When the bone has a crack, it is said to be a stress fracture.

What Is a Pelvic Fracture?

A pelvic fracture is a break or disruption of one or more pelvis bones. The pelvis is the area located below the abdomen and between the hip bones. These fractures are of the uncommon type seen in only three percent of all adult bone fractures. These fractures can be seen in any age group. Mid-pelvic fractures are more commonly seen in older people since their bones weaken due to osteoporosis. The severity of these fractures ranges from mild to moderate depending upon the force they were hit by.

The bones that constitute the pelvis area are-

• The sacrum.

• The coccyx.

• The three hip bones are the ilium, the ischium, and the pubis.

Combined, these bones form a structure known as a pelvic ring. The pelvis ring is a firm structure that supports many important and sensitive internal organs of the body, like nerves, blood vessels, reproductive organs, the bladder, and the lower part of the digestive tract. It is also considered an anchor for the leg muscles.

What Are the Types of Pelvic Fractures?

Pelvic fractures are of many types, as multiple bones constitute hem. Depending upon the pattern of the bone fracture, it can be divided into the following categories-

• Stable Fractures: In this type of fracture, there is usually a single break in the pelvis, and the parts of the bone that are broken are not displaced. A stable pelvic fracture happens when low-intensity events such as minor falling or running occur.

• Unstable Pelvic Fractures: In this type of fracture, there are usually two or more breaks in the pelvis, and the parts of the broken bone are displaced. An unstable pelvic fracture occurs when high-intensity events such as car rash occur.

• Avulsion Fracture: It is another type of fracture that happens when the tendon or ligament gets torn away from the bone it was attached to, taking a small fragment of bone with it.

What Are the Causes of Pelvic Fractures?

These fractures are caused due to the following reasons-

• High-impact Trauma: Such as falling from a great height or a car accident. Due to this, mostly unstable pelvic fractures occur.

• Due to Bone Weakening: Especially in older age due to bone weakening diseases such as osteoporosis. Due to bone weakening, stable pelvic fractures are caused.

• Athletic Activities: This is a rare type but is caused due to sports injuries. Due to such activities, most avulsion fractures occur.

What Are the Signs and Symptoms of Pelvic Fractures?

The symptoms depend on the severity of the fracture. The signs and symptoms of a pelvic fracture include-

• Pain in the lower back, hip, and groin region.

• Pain in the legs aggravates while walking or moving.

• Numbness or tingling sensation in the groin area or legs.

• Pain in the abdomen region

• Swelling in the hip region.

• Sometimes, bruising in the hip area is seen.

• Difficulty in peeing is also experienced sometimes.

How Is a Pelvic Fracture Diagnosed?

Pelvic fractures are diagnosed with the help of imaging techniques-

• X-rays: X-rays are used to take pictures of all the bones with the help of radiation. X-rays examine which part of the bone is fractured from all angles.

• CT scan: Computed tomography scans are done to get detailed images of the broken bone and to check whether other parts are involved.

• MRI: Magnetic Resonance Imaging is done through magnetic and radio waves and computer techniques to check all the affected bones and parts.

What Is the Management and Treatment of Pelvic Fractures?

Treatment depends upon some of the factors, such as:

1. The severity of the fracture.

2. Pattern or the type of fracture.

3. The amount of displacement of bones.

The treatment is of two types:

Non-Surgical Treatment: This is done in cases where the fracture's severity is very low, and the bones are not displaced much. Usually, a stable fracture requires this treatment. The treatment includes:

• Rest: Doctors advise rest to avoid extra stress on the fracture.

• Walking Aids: To avoid stress on the fractured area, doctors may advise using a walker, crutches, or wheelchair.

• Medications: Certain medications are advised to relieve pain. Anticoagulants (blood thinners) are also advised to prevent clot formation in the veins of the legs and pelvis.

Surgical Treatment: This is required in case of a severe or unstable fracture. Different surgeries include:

• External Fixation: To stabilize the pelvic fracture. Metal pins or screws are inserted into the bones through small incisions in the skin and muscles. The pins and screws stick out of the skin on both sides of the pelvis and are attached to bars outside the body.

• Internal Fixation: In this surgery, the displaced bone fragments are repositioned in normal alignment. The components are attached to the bone's outer surface with the help of screws or metal plates.

• Skeletal Traction: A pulley system of weights and counterweights outside the body helps realign the bones. In this technique, metal pins are implanted by the surgeon in the thigh bone that sticks out of the bone and helps position the leg. Weight is added to these pins, which help gently pull the leg keeping the broken bone fragments aligned. It is placed immediately after the trauma and is removed after the surgery.

Conclusion

This article gives details of pelvic fractures. A pelvic fracture is a break or disruption of the bones present in the pelvis region. These are very uncommon types of fractures. The pelvis fracture can be of the stable and unstable type; avulsion is also a type of pelvis fracture but is rarely seen. The treatment depends upon the type and the severity of the fracture.