Pelvic Fractures
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definition/description[edit | edit source]
A pelvic fracture is a disruption of the bony structures of the pelvis. The pelvis consists of the ilium, ischium and pubis. These form an anatomic ring with the sacrum. Disruption of the ring requires a lot of energy. Because in most of the cases pelvic fractures are caused by high impact, it is possible that organs in the bony pelvis are affected. Trauma to extra-pelvic organs is common. They are often associated with severe hemorrhage due to the extensive blood supply to the region. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Pelvic fractures are associated with a high morbidity and mortality. Emergency care with primary aim reducing blood loss is always necessary. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
There are two classification systems who are used most commonly to describe pelvic fractures:
Classification of pelvic fractures by Tile is based on the integrity of the posterior sacroiliac complex. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
• Type A: rotationally and vertically stable, the sacroiliac complex is intact. Mostly managed nonoperatively.
o A1: avulsion fractures
o A2: stable iliac wing fractures or minimally displaced pelvic ring fractures
o A3: transverse sacral or coccyx fractures
• Type B: rotationally unstable and vertically stable, caused by external or internal rotational forces, results in partial disruption of the posterior sacroiliac complex.
o B1: open-book injuries
o B2: LC injuries
o B3: bilateral type B injuries
• Type C: rotationally unstable and vertically unstable, complete disruption of the posterior sacroiliac complex, result of great force.
o C1: unilateral injury
o C2: bilateral injuries in which one side is a type B and the controlateral side is a type C injury
o C3: bilateral injury in which both sides are type C injuries
Classification of pelvic fractures by Young and Burgess is based on mechanism of injury: lateral compression, anteroposterior compression, vertical shear or a combination of forces. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
• Grade I: associated sacral compression on side of impact. Associated widening of pubic symphysis or of the anterior sacroiliac joint, while ligaments remain intact.
• Grade II: associated posterior iliac fracture on side of impact. Associated widening of the anterior SI joint caused by disruption of the anterior SI, sacrotuberous and sacrospinous ligaments, posterior ligaments remain intact.
• Grade III: associated controlateral sacroiliac joint injury. Complete SI joint disruption with lateral displacement and disrupted anterior SI, sacrotuberous, sacrospinous and posterior SI ligaments.
Epidemiology/ etiology[edit | edit source]
Pelvic fractures have an incidence of 37 cases per 100000 person-years in the United States. The appearance of pelvic fractures is the greatest in people aged between 15-28 years. In persons younger than 35, pelvic fractures occur more in males than females. In persons older than 35, pelvic fractures occur more in females than males. In younger people pelvic fractures occur mostly as result of high-energy mechanisms, in older people they occur from minimal trauma, such as a low fall. Elderly people with Osteoporosis have a higher risk factor. Low- energy fractures are usually stable fractures of the pelvic ring. High-energy pelvic fractures occur most commonly after motor vehicle crashes, motorcycle crashes, motor vehicles striking pedestrians and falls. This are mostly avulsion fractures of the superior or inferior iliac spines or with apophyseal avulsion fractures of the iliac wing or ischial tuberosity. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
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