Pelvic fractures

Pelvic fractures account for about 2% of all fractures. However, in polytrauma, pelvic fractures occur in 20% of cases. These fractures are usually caused by direct, but more rarely by indirect, forces of significant energy. A typical cause is traffic accidents or falls from heights. Since the pelvis closely presses on the organs of the urogenital and gastrointestinal system, on the vessels and nerves, injuries to the skeleton are often accompanied by damage to these structures.

AO classification
=Type A fractures= These include isolated fractures of individual bones of os coxae, transverse fractures of the sacrum and the coccyx. Furthermore, avulsion fractures of attachment parts of bones arising from muscle contraction.

Clinical picture and diagnosis
In stable fractures, the patient experiences pain and hematoma at the injury site, the patient cannot walk, and the function of the hip joint is limited. X-ray examination is used for diagnosis, when front-back, east and entrance projection are performed. The diagnosis is then confirmed and refined by CT scan.

Therapy
For most type A fractures, conservative treatment is chosen, with the patient lying in bed for several days. After the pain subsides, he starts walking on crutches. Dislocated fractures are resolved by bloody reposition and osteosynthesis. =Type B and C fractures= Type B fractures result from external or internal rotation of the pelvis longitudinally around the axis of the body. Examples are partial injuries to the posterior segment of the pelvic ring or open book fractures. In type C fractures, one or both parts of the pelvis detach from the pelvic ring. Death occurs in more than 25% of cases.

Clinical picture and diagnosis
The patient is usually in shock from the massive bleeding. If he is conscious, he is troubled by pain in the sacral region and lower abdomen. The goal of the clinical examination is to detect pelvic instability. The diagnosis is confirmed by an front-back, entrance and exit image during X-ray examination and CT examination.

Complications
These fractures are often accompanied by complications. There is damage to the urogenital tract. Diagnosis is made by excretory urography or CT with a contrast substance. Operation, suturing of the bladder, reconstruction of the urethra, drainage of urine with a catheter or diversion of urine by suprapubic puncture is necessary. Injuries to the rectum and small intestine occur less frequently. The patient is most at risk of blood loss and embolism.

Therapy
Anti-shock treatment is started, bleeding is stopped and the pelvic ring is stabilized. It is necessary to reposition and stabilize the pelvis with an external fixator as soon as possible. In type B injuries, the anterior segment of the pelvis is fixed with a plate or external fixator, in type C, a plate or external fixator is used to stabilize the anterior segment, the posterior segment is fixed with screws, a splint or bolts. =Acetabulum fractures= Fractures of the pelvis can also include acetabular fractures, which are a typical example of intra-articular fractures.

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Related articles

 * Pelvis
 * Fracture types