Fractures of the pelvis consist of a break of the pelvic ring and carry a high risk for significant complications and even death. Because of the high energy needed, pelvic fractures may occur concomitantly with other injuries requiring immediate emergency care to prevent or address serious bleedings and further damage to internal organs. Although more common in young individuals, pelvic injuries are on the rise in the elderly mostly due to low impact falls on weaker osteoporotic bones.
The image depicts a variety of pelvic fractures caused by different forces, each one producing type A, B or C fracture types according to the TILE classification.
The characteristics of pelvic fractures are so heterogeneous to warrant different classification criteria depending on the mechanisms of injury and the bony elements involved, whether the pelvic ring, the acetabulum or the sacrum and coccyx. Due to the complexity of the fracture types, the modalities of surgical repair also vary significantly in view of the severity of the injuries to the abdominal organs, which may require a two-stage approach, one being a temporary stabilisation until the patient is no longer in critical conditions, followed by a second definitive open reduction internal fixation.
As reported in a TAC-funded study, surgical treatment of pelvic fractures has shown to improve long-term outcomes and reduce morbidity and mortality when compared to conservative management.
Epidemiology of pelvic fractures in Australia
A few years back, in Australia the yearly incidence of pelvic fractures was 23 per 100,000. Pelvic fractures represented approximately 3% of all skeletal injuries and comprise 8-9.3% of all traumas admitted to hospital.
The pelvic region is highly vascularised by an intricate network of veins and arteries (above) and a large number of abdominal organs (below). This anatomical feature makes the lower abdomen susceptible to vascular damage and bleeding.
The overall mortality of pelvic fractures ranges from 5-16%, increasing in unstable fractures. Although comprising only 2-4% of all fractures, open pelvic fractures are associated with a mortality rate of up to 45%. Higher death rates are especially relevant for patients presenting with pelvic fractures who are in shock, as well as patients over 65 years of age with incidence of death rising to 20%. The cause of death is mostly due to internal injuries.
The lower abdominal cavity enclosed by the pelvis ring contains many organs that could be damaged with a pelvic fracture (i.e. bladder, intestine, male and female sexual organs as well as the vascular and neural components).
The Victorian Orthopaedic Trauma Outcome Registry (VOTOR) reported that adult pelvic fractures due to traumatic injuries treated in Victorian major trauma services are the most common fractures following the spine with 1,030 cases, comprising 14.9% of all fractures over 12 months between 2018-19.
The industries in which pelvic fractures are more frequent include transport, construction, agriculture, mining, and manufacturing, typically caused by falls and being hit by falling objects, or trapped between stationary/moving objects, and vehicle accidents.
The significance of pelvic injuries in the legal space is shown by this data. According to the Australian Workers’ Compensation Statistics, the number of claims for abdomen/pelvic injuries in 2017-18 was 2,775, out of 107,335 serious claims for all bodily locations, which totals 2.6% of all claims. The median compensation paid for the combination of all fractures was $15,600 and time lost 8 weeks.
To access the pathology pelvic fractures including their classifications, causes, risk factors, diagnosis and different approaches to conservative and surgical treatments follow thislink.
Learn about the anatomy of the pelvis and hip
Find the details of the examination of the pelvis and hip
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