Pelvic fracture
Encyclopedia
Pelvic fracture is a disruption of the bony structure of the pelvis
, including the hip bone
, sacrum
and coccyx
. The most common cause in elderly is a fall, but the most significant fractures involve high-energy forces such as a motor vehicle accident, cycling accidents, or a fall from significant height. Diagnosis is made on the basis of history, clinical features and special investigations usually including X-ray
and CT
. Because the pelvis cradles so many internal organs, pelvic fractures may produce significant internal bleeding which is invisible to the eye. Emergency treatment consists of advanced trauma life support
management. After stabilisation, the pelvis may be surgically reconstructed.
Pelvic fractures are most commonly described using one of two classification systems.
The Tile classification system is based on the integrity of the posterior sacroiliac complex.
In type A injuries, the sacroiliac complex is intact. The pelvic ring has a stable fracture that can be managed nonoperatively.
Type B injuries are caused by either external or internal rotational forces resulting in partial disruption of the posterior sacroiliac complex. These are often unstable.
Type C injuries are characterized by complete disruption of the posterior sacroiliac complex and are both rotationally and vertically unstable. These injuries are the result of great force, usually from a motor vehicle crash, fall from a height, or severe compression.
The Young classification system is based on mechanism of injury: lateral compression, anteroposterior compression, vertical shear, or a combination of forces. Lateral compression (LC) fractures involve transverse fractures of the pubic rami, either ipsilateral or contralateral to a posterior injury.
Grade I - Associated sacral compression on side of impact
Grade II - Associated posterior iliac ("crescent") fracture on side of impact
Grade III - Associated contralateral sacroiliac joint injury
One specific kind of pelvic fracture is known as an 'open book' fracture. This is often the result from a heavy impact to the groin
(pubis), a common motorcycling accident injury. In this kind of injury, the left
and right
halves of the pelvis are separated at front and rear, the front opening more than the rear, i.e. like opening a book. Depending on the severity, this may require surgical reconstruction before rehabilitation.
In lieu of surgery, some pelvic fractures are treated with only bed rest. Pelvic fractures may involve months of recovery and months or years of rehabilitation.
skull
Pelvis
In human anatomy, the pelvis is the lower part of the trunk, between the abdomen and the lower limbs .The pelvis includes several structures:...
, including the hip bone
Hip bone
The hip bone, innominate bone or coxal bone is a large, flattened, irregularly shaped bone, constricted in the center and expanded above and below...
, sacrum
Sacrum
In vertebrate anatomy the sacrum is a large, triangular bone at the base of the spine and at the upper and back part of the pelvic cavity, where it is inserted like a wedge between the two hip bones. Its upper part connects with the last lumbar vertebra, and bottom part with the coccyx...
and coccyx
Coccyx
The coccyx , commonly referred to as the tailbone, is the final segment of the vertebral column. Comprising three to five separate or fused vertebrae below the sacrum, it is attached to the sacrum by a fibrocartilaginous joint, the sacrococcygeal symphysis, which permits limited movement between...
. The most common cause in elderly is a fall, but the most significant fractures involve high-energy forces such as a motor vehicle accident, cycling accidents, or a fall from significant height. Diagnosis is made on the basis of history, clinical features and special investigations usually including X-ray
X-ray
X-radiation is a form of electromagnetic radiation. X-rays have a wavelength in the range of 0.01 to 10 nanometers, corresponding to frequencies in the range 30 petahertz to 30 exahertz and energies in the range 120 eV to 120 keV. They are shorter in wavelength than UV rays and longer than gamma...
and CT
Computed tomography
X-ray computed tomography or Computer tomography , is a medical imaging method employing tomography created by computer processing...
. Because the pelvis cradles so many internal organs, pelvic fractures may produce significant internal bleeding which is invisible to the eye. Emergency treatment consists of advanced trauma life support
Advanced Trauma Life Support
Advanced Trauma Life Support is a training program for medical doctors in the management of acute trauma cases, developed by the American College of Surgeons. Similar programs exist for nurses and paramedics...
management. After stabilisation, the pelvis may be surgically reconstructed.
Pathophysiology
The bony pelvis consists of the ilium (i.e., iliac wings), ischium, and pubis, which form an anatomic ring with the sacrum. Disruption of this ring requires significant energy. Because of the forces involved, pelvic fractures frequently involve injury to organs contained within the bony pelvis. In addition, trauma to extra-pelvic organs is common. Pelvic fractures are often associated with severe hemorrhage due to the extensive blood supply to the region.Pelvic fractures are most commonly described using one of two classification systems.
The Tile classification system is based on the integrity of the posterior sacroiliac complex.
In type A injuries, the sacroiliac complex is intact. The pelvic ring has a stable fracture that can be managed nonoperatively.
Type B injuries are caused by either external or internal rotational forces resulting in partial disruption of the posterior sacroiliac complex. These are often unstable.
Type C injuries are characterized by complete disruption of the posterior sacroiliac complex and are both rotationally and vertically unstable. These injuries are the result of great force, usually from a motor vehicle crash, fall from a height, or severe compression.
The Young classification system is based on mechanism of injury: lateral compression, anteroposterior compression, vertical shear, or a combination of forces. Lateral compression (LC) fractures involve transverse fractures of the pubic rami, either ipsilateral or contralateral to a posterior injury.
Grade I - Associated sacral compression on side of impact
Grade II - Associated posterior iliac ("crescent") fracture on side of impact
Grade III - Associated contralateral sacroiliac joint injury
One specific kind of pelvic fracture is known as an 'open book' fracture. This is often the result from a heavy impact to the groin
Groin
In human anatomy, the groin areas are the two creases at the junction of the torso with the legs, on either side of the pubic area. This is also known as the medial compartment of the thigh. A pulled groin muscle usually refers to a painful injury sustained by straining the hip adductor muscles...
(pubis), a common motorcycling accident injury. In this kind of injury, the left
Left
Left may refer to:* Left * Left , 2006* Left * Left-wing politics, the political trend or ideology...
and right
Right
Rights are legal, social, or ethical principles of freedom or entitlement; that is, rights are the fundamental normative rules about what is allowed of people or owed to people, according to some legal system, social convention, or ethical theory...
halves of the pelvis are separated at front and rear, the front opening more than the rear, i.e. like opening a book. Depending on the severity, this may require surgical reconstruction before rehabilitation.
In lieu of surgery, some pelvic fractures are treated with only bed rest. Pelvic fractures may involve months of recovery and months or years of rehabilitation.
See also
- Coccyx (tailbone)CoccyxThe coccyx , commonly referred to as the tailbone, is the final segment of the vertebral column. Comprising three to five separate or fused vertebrae below the sacrum, it is attached to the sacrum by a fibrocartilaginous joint, the sacrococcygeal symphysis, which permits limited movement between...
- Ileum boneIlium (bone)The ilium is the uppermost and largest bone of the pelvis, and appears in most vertebrates including mammals and birds, but not bony fish. All reptiles have an ilium except snakes, although some snake species have a tiny bone which is considered to be an ilium.The name comes from the Latin ,...
- PelvisPelvisIn human anatomy, the pelvis is the lower part of the trunk, between the abdomen and the lower limbs .The pelvis includes several structures:...
- SacrumSacrumIn vertebrate anatomy the sacrum is a large, triangular bone at the base of the spine and at the upper and back part of the pelvic cavity, where it is inserted like a wedge between the two hip bones. Its upper part connects with the last lumbar vertebra, and bottom part with the coccyx...
skull
Skull
The skull is a bony structure in the head of many animals that supports the structures of the face and forms a cavity for the brain.The skull is composed of two parts: the cranium and the mandible. A skull without a mandible is only a cranium. Animals that have skulls are called craniates...