Pelvic fractures
Pelvic fractures account for about 2% of all fractures.[1] However, in polytrauma, pelvic fractures occur in 20% of cases.[1] 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[edit | edit source]
| Type A | stable fractures | the stability of the pelvic ring is not affected |
| Type B | rotationally unstable fractures | instability in one (horizontal) plane |
| Type C | rotationally and vertically unstable fractures | instability in multiple planes |
Type A fractures[edit | edit source]
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[edit | edit source]
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[edit | edit source]
For most type A fractures, conservative treatment is chosen, with the patient lying in bed for several days. After the pain subsides, the patient will start walking on crutches. Dislocated fractures are resolved by bloody reposition and osteosynthesis.
Type B and C fractures[edit | edit source]
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.[2]
Clinical picture and diagnosis[edit | edit source]
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[edit | edit source]
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[edit | edit source]
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[edit | edit source]
Fractures of the pelvis can also include acetabular fractures, which are a typical example of intra-articular fractures.
For more information see Acetabulum fractures.
Links[edit | edit source]
Related articles[edit | edit source]
References[edit | edit source]
Literature[edit | edit source]
- ZEMAN, Miroslav. Speciální chirurgie. - edition. Galén, 2014. 511 pp. ISBN 9788074921285.
- KOUDELA, Karel, et al. Ortopedická traumatologie. 1. edition. Karolinum, 2002. 147 pp. ISBN 80-246-0392-6.
- VIŠŇA, Petr – HOCH, Jiří, et al. Traumatologie dospělých : učebnice pro lékařské fakulty. 1. edition. Praha : Maxdorf, 2004. 157 pp. ISBN 80-7345-034-8.
