Pelvis is a ring-like structure of bones that is present at the lower end of the trunk. The pelvic bone is a large bone, which is present in two halves on each side of the body known as the hemipelvises, and together they build up the complete pelvis. The hemipelvis on each side consists of amalgamation of three bones called as the ilium, pubis and ischium. Ilium, pubis and ischium are three separate bones before puberty which are held together by cartilage. Eventually with growing age, these three bones fuse together into one single bone. Ligaments are strong connective tissues that connect the pelvis to the large triangular bone known as sacrum present at the base of the spine. This forms a bowl-like cavity under the rib cage.
Reproductive and several digestive organs are situated within the pelvic ring. Blood vessels and large nerves going to the legs pass through this pelvic ring. The pelvis works as a connecting point for muscles that reach up into the trunk and down into the legs. Due to these important structures that pass through the pelvis, pelvic fracture or fractured pelvis may be associated with nerve injury, internal organ damage, and substantial bleeding.
A pelvic fracture or fractured pelvis is a condition which occurs due to a crack or a break in any of the three bones that are a part of the pelvis.
Pelvic fracture or fractured pelvis is more common among growing teens, particularly those who are involved in sports. Several pulled muscles, which usually result from sudden muscle contractions, can cause avulsion fractures of the pelvis, which may be undetected. A small piece of bone that belongs to the ischium the connecting point of the hamstring muscles tears off by these pulled muscles. However, this kind of fracture neither makes the pelvis unstable nor does it injure any internal organs.
In some cases osteoporosis in elderly people could also be a reason for pelvic fracture. Pelvic fracture or fractured pelvis may occur when an individual falls such as while descending stairs and while coming out of the bathtub. However, these types of injuries do not damage the structural integrity of the pelvic ring, but may result in fracturing of an individual bone.
In most of the cases, pelvic fracture or fractured pelvis are often associated with high-energy forces, such as in motor vehicle accident, falls and crush accident. Depending upon the degree and direction of the force the injury may also be life-threatening and surgical treatment may necessarily be required.
Classification and Types of Pelvic Fracture or Fractured Pelvis
Pelvic fractures are broadly classified into three types depending upon the degree and severity of the fracture:
- Grade A Fractures: Grade A fractures are stable and minor type of fractures. Grade A fractures may include avulsion fractures like rectus femoris avulsion, and fracture in any of the iliac bones.
- Grade B Fractures: Grade B fractures are rotationally unstable. Grade B fractures often result in widening of the SI joints and separation of the pubic symphysis.
- Grade C Fractures: Grade B fractures are rotationally and vertically unstable which disrupt the pelvic ring totally. The injuries are extremely severe, which are often associated with high fatality rate and multiple complications.
Causes and Risk Factors of Pelvic Fracture or Fractured Pelvis
The pelvis is a very strong structure and therefore it fractures only due to a large force. In some cases, osteoporosis in elderly people may also cause pelvic fracture due to weak bones which are prone to fracture. Avulsion fractures of the pelvis in which muscle pulls away a small piece of bone may also be seen in athletes.
Pelvic fractures are caused most commonly from high impact forces such as a motorbike or car accident and due to falling down from a great height.
Signs and Symptoms of Pelvic Fracture or Fractured Pelvis
Symptoms of a fractured pelvis vary with each patient depending upon the type and severity of the fracture. A minor avulsion fracture may demonstrate only a minor bruising. However, other symptoms include:
- Sudden pain on impact.
- Development of swelling and bruising within 48 hours of injury.
- Pain on movements particularly of the hip.
- Tingling or cold, numbness, pale skin in the legs indicative of nerve and blood vessel damage.
- Symptoms of grade C injuries often lead to internal bleeding.
- Symptoms of shock like racing pulse, cold, nausea, light-headedness, loss of consciousness and clammy skin may also be experienced.
Treatment for Pelvic Fracture or Fractured Pelvis
Stable fractures like avulsion fracture usually heal up without surgery. Using crutches and a walker for about three months helps in keeping the weight off from the legs during the healing period of fracture. Medications are also prescribed for reducing pain. Due to limited mobility for a long duration, blood thinners are also helpful in reducing the risk of blood clots developing in the veins of the legs.
Pelvic fractures resulting from high-energy forces are often life-threatening injuries due to extensive bleeding. In such cases, external fixator is used for stabilizing the pelvic region. External fixator consists of long screws which are inserted into the bones on each side in order to connect it to the frame present on the outer side of the body. The external fixator also addresses the internal injuries to blood vessels, nerves and organs.
Assessment of each case must be done individually specifically in case of unstable fractures. Traction may also be required in some cases whereas in others an external fixator may be enough. Surgical insertion of plates or screws is usually required in case of unstable fractures.
Exercises for Pelvic Fracture or Fractured Pelvis
Exercises may need to be performed during recovery period to regain regular function. Given below are some of the exercises.
Hip and Knee Bend to Straighten Exercise for Pelvic Fracture or Fractured Pelvis
This exercise is performed by bringing the knee near the chest as far as possible in order to bend the knee until a mild to moderate pain free stretch is felt. Then return back to the initial position. Perform 10 to 20 times ensuring there is no exacerbation of symptoms. Repeat the same on the other leg.
Hip External Rotation Exercise for Pelvic Fracture or Fractured Pelvis
This exercise is performed by lying down on the back with foot flat and knee bent. Now move the knee sideways as far as possible until a mild to moderate pain free stretch is felt and return back to the initial position. Perform 10 to 20 times ensuring there is no exacerbation of symptoms. Repeat the same on the other leg.
Bridging Exercise for Pelvic Fracture or Fractured Pelvis
This exercise is performed by lying down on the back, bending the legs with knees facing towards the ceiling and feet flat on the floor. Gradually raise the bottom by pushing it with the help of feet in order to bring the hip, shoulder and knee in a straight line by tightening the bottom muscles. Hold the position for about two seconds until a pain free stretch is felt. Repeat 10 times.
Exercises for Pelvic Fracture to Regain Regular Function
Tests to Diagnose Pelvic Fracture or Fractured Pelvis
Typically an x-ray is required for confirming the severity of the pelvic fractures. The x-rays taken from different angles usually exhibit the actual place and position of the affected bones. CT scan may not only determine the extent of the pelvic injury but also help in ruling out other associated injuries. Examination of the blood vessels and nerves of the legs is also performed to find out any other injuries.