Pelvic Fractures

Pelvis Fractures

Anatomy

The pelvis is a ring-like structure of bones at the lower end of the trunk. The two sides of the pelvis are actually three bones (ilium, ischium, and pubis) that grow together as people age. Strong connective tissues (ligaments) join the pelvis to the large triangular bone (sacrum) at the base of the spine. This creates a bowl-like cavity below the rib cage. On each side, there is a hollow cup (acetabulum) that serves as the socket for the hip joint.

Many digestive and reproductive organs are located within the pelvic ring. Large nerves and blood vessels that go to the legs pass through it. The pelvis serves as an attachment point for muscles that reach down into the legs and up into the trunk of the body. With all of these vital structures running through the pelvis, a pelvic fracture can be associated with substantial bleeding, nerve injury, and internal organ damage.

Management of Exsangunating Pelvis Injuries

Introduction

Trauma patients who present with unstable pelvic fractures have sustained a high energy injury that is commonly associated with disruption of arteries and veins resulting in major hemorrhage. Patients with pelvic fractures who present in shock have a mortality of 30-50%. When combined with injuries in other body regions such as the abdomen, the mortality rises even higher, approaching 100% in some series. However a systematic multidisciplinary approach to these injuries, directed initially only at hemorrhage control, can lead to significant improvements in survival.

Key Points

Pelvic Injury

• An unstable pelvic injury with signs of shock should be treated as a vascular injury.
• Hemorrhage may be from fractured bone and disrupted veins and arteries.
• High energy trauma is associated with multi-cavity injury, and there may be hemorrhage in the chest or abdomen as well as the pelvis and long bones.

Management

• A multidisciplinary approach is essential. All team members must know their roles and key decisions.
• Appropriate resuscitation maneuvers are as important as hemorrhage control interventions.
• Management of massive transfusion, coagulopathy and hypothermia are vital for success.
• A damage control approach should be adopted for all these patients: do the minimum necessary to save life.