Pelvic fractures are rare. They can be caused by extreme trauma, such as a fall from a great height or a road traffic accident. However, older people with osteoporosis can fracture their pelvis simply by falling over. In medicine, a distinction is made between stable and unstable pelvic fractures. Stable pelvic fractures are usually treated conservatively. An unstable pelvic fracture is an emergency and must be surgically stabilised as soon as possible.
The pelvis consists of several bones that form a ring and connect the spine with the legs. A relatively simple fall can cause a pelvic fracture in older people – particularly older women – who have osteoporosis. Younger people only suffer pelvic fractures if they are subject to extreme trauma, such as falling from a great height or being involved in a road traffic accident. Depending on which pelvic bones are affected, the diagnosis will either be a stable or unstable pelvic fracture. With stable fractures, the bony pelvis is not damaged, so the pelvis remains stable. If the bony pelvis is damaged this is called an unstable pelvic fracture, because the pelvis becomes unstable or loose. Unstable pelvic fractures are dangerous, because the instability of the pelvis can lead to blood vessel damage and life-threatening internal bleeding.
A stable pelvic fracture usually causes fewer symptoms than an unstable fracture. Typical symptoms include pain and swelling around the pelvis, as well as limited mobility of one leg. If the bony pelvis is broken, it will be impossible to walk. Blood-stained urine, an extremely rapid pulse and a pale face can indicate damaged blood vessels or internal organs. If a person exhibits these symptoms, it is a medical emergency and they must undergo immediate surgery.
Various different examinations are used to diagnose a pelvic fracture. These include a careful manual examination of the pelvis, radiological imaging and the identification of any sources of bleeding.
Stable pelvic fractures generally do not require surgery. The conservative treatment consists of bed rest, pain relieving medication and physiotherapy exercises
Unstable pelvic fractures must be surgically treated. If there is heavy bleeding, the person’s circulatory system will need to be stabilised before the operation can take place. Then during the operation, the source of the bleeding will be stopped and the pelvis will be surgically stabilised. This is usually achieved using an external fixation device. Find out more about this in the osteosynthesis section.