Pelvic fractures refer to the fractures that are caused between the bones of the pelvic grid. Estimates suggest that about 1 to 3% of all fractures comprise of pelvic fractures and contribute to about 2% of all orthopedic causes of hospitalization. Pelvic fractures usually have a bimodal pattern with the prevalence of the condition high in people between the age group of 20 to 40 years and people older than 65 years.
Most pelvic fractures are stable and caused primarily due to low energy mechanism of injury. However, when a pelvic fracture is caused due to a high energy mechanism, it is usually unstable. Motor vehicle accidents tend to disrupt the pelvic ring. Three different patterns of injury have been identified,
- With side impact or collisions, lateral compression of the pelvic ring is observed.
- With head on collisions, an anterior posterior force results in opening of the pelvic ring and can also result in external rotation of the innominate bones.
- A combination of the two patterns may also be observed.
Estimates from the United States has suggested that the mortality rates associated with pelvic fractures range between 9 to 20% but the mortality rate can be as high as 50%, if the fracture is associated with significant blood loss.
Complications Of Unstable Pelvic Fracture
There are several complications associated with unstable pelvic fractures,
- Morel- Lavalle lesions are characterized by cavity filled with hematoma (large blood clots) with liquefied fat tissue. This condition if not managed can lead to high risk of infection and septicemia.
- Deep Vein Thrombosis is another common complication and is reported in 35 to 60% of patients with pelvic fracture. However pulmonary embolism is relatively rare in about 2% of the cases. The risk factors include older age, spinal cord injury and lower duration of immobilization.
- Sciatic or lumbosacral nerve injury is found to be present in about 10 to 15% of patients with pelvic fracture or trauma. The anatomical proximity of the nerve roots with the sacroiliac joint is considered to be the primary factor.
- Malunions or Nonunions are often observed in cases of pelvic fracture which may be manifested in the form of pain and trouble sitting up or lying down.
How To Manage Unstable Pelvic Fracture?
The management requires a multidisciplinary approach to ensure prompt recovery and limit the severity of the associated complications.
- Immediate treatment includes airway stabilization followed by stabilization of circulation, either by using blood transfusion or blood expanders, to compensate for blood loss.
- The displaced fracture is temporary stabilized by simple means to facilitate transportation of the patient to a healthcare facility.
- After the patient is stabilized and the general medical condition of the patient improves, a surgical intervention is inevitable, especially in case of unstable fracture.
- The goal of surgery is to treat the fracture without causing malunion, nonunion or other complications. External fixation is used for rotational unstable pelvic fractures.
- Post-surgical care comprises of healthy diet, rest and physical therapy exercises to improve the strength of the pelvic muscles and hasten the healing process. Calcium and vitamin supplements may be provided to improve calcium metabolism and promote bone fusion.
- Homeopathic drugs like Calcaria Phos and Calcaria Carb are considered to be very useful to hasten joint fusion and treat unstable pelvic fractures.
A regular follow up is important to ensure that the healing process is on the right track and avoid complications.