Diagnosis
The diagnosis of a pelvic ring fracture is made classically by anamnesis, physical examination and imaging. In the anamnesis, the doctor asks about the course of the accident, the symptoms and accompanying current restrictions. Also of interest are existing underlying diseases that can affect bone stability, for example whether osteoporosis or bone tumours are present.
During the subsequent physical examination, the physician pays attention to whether there are visible indications of a fracture, for example asymmetry of the pelvis, swelling or haematomas. He then palpates the bony pelvis and looks for abnormal mobility of the pelvic bones, whether they are movable in relation to each other or whether there is pain due to pressure or compression of the pelvis. He will then examine whether mobility and sensitivity in the hip or leg are restricted.
The physical examination is followed by imaging measures. First, x-rays are taken in several planes, which allow an initial assessment of the bony situation. In most cases, this is followed by a computer tomography of the pelvis and the abdomen for a more precise assessment.
This, like an ultrasound examination of the abdomen, is very important to assess the abdominal organs and to rule out bleeding and injuries. The differential diagnosis of a pelvic ring fracture must be distinguished from pelvic contusions and arthrosis. Knee injuries, where the pain is often projected into the hip, must also be excluded.
This is a very common phenomenon in children. Acute therapy at the scene of the accident when there is a justified suspicion of a pelvic ring fracture consists of immobilisation and stabilisation of the pelvis by means of a pelvic clamp or ligaments (pelvic sling) to prevent further displacement of the bone fragments. In addition, the pelvic space should be kept as small as possible by this stabilizing compression in order not to create space for the expansion of a potential bleeding.
As a result, the internal bleeding at best compresses itself. The inpatient treatment of a pelvic ring fracture depends largely on the type of fracture and the concomitant injuries. A type A fracture with an intact pelvic ring is usually treated conservatively, i.e. non-surgically.
Here, the focus of treatment is on adequate pain therapy and early mobilisation of the patient by means of physiotherapy. The fracture then heals on its own and without complications. Physiotherapy plays an important role in the healing process.
A type B pelvic ring fracture with rotational instability is treated either conservatively or surgically, depending on the severity of the accompanying injuries. A type C pelvic ring fracture represents an absolute surgical indication. Here, absolute pelvic instability is present, which is why the overriding therapeutic objective is reduction, i.e. the restoration of the original arrangement of the bones in the pelvic ring and adequate fixation and stabilization of the structures involved.
If the surrounding tissue is unaffected, the bone fragments are fixed intraoperatively using osteosynthesis procedures, i.e. with the aid of screws and plates. However, if the soft tissue is severely injured, surgical procedures that are gentle on the soft tissue must be used. A so-called external fixator is used for this purpose.
This is a construct that temporarily fixes the pelvic bones and thus prevents a deterioration of the fracture situation, but has its connecting axis outside the body and thus, in contrast to other osteosynthesis procedures, spares the soft tissue. Once the surrounding tissue has healed, the definitive operation to restore the bony conditions can then be followed. Depending on the degree of injury to neighbouring organs, separate procedures must be used, such as reconstruction and closure of an injured intestinal section.
Depending on the surgical procedure used, different lengths of bed rest are required after the operation, whereby physiotherapeutic exercises should be carried out to build up and maintain the muscles even if the patient is on bed rest for a long time. Physiotherapy plays an important role in the healing process. A type B pelvic ring fracture with rotational instability is treated either conservatively or surgically, depending on the severity of the concomitant injuries.
A type C pelvic ring fracture represents an absolute surgical indication. Here, absolute pelvic instability is present, which is why the overriding therapeutic objective is reduction, i.e. the restoration of the original arrangement of the bones in the pelvic ring and adequate fixation and stabilization of the structures involved. If the surrounding tissue is unimpaired, the bone fragments are fixed intraoperatively using osteosynthesis procedures, i.e. with screws and plates.
However, if the soft tissue is severely injured, surgical procedures that are gentle on the soft tissue must be used. A so-called external fixator is used for this purpose. This is a construct that temporarily fixes the pelvic bones and thus prevents a deterioration of the fracture situation, but has its connecting axis outside the body and thus, in contrast to other osteosynthesis procedures, spares the soft tissue.
Once the surrounding tissue has healed, the definitive operation to restore the bony conditions can then be followed. Depending on the degree of injury to neighbouring organs, separate procedures must be used, such as reconstruction and closure of an injured intestinal section. Depending on the surgical procedure used, different lengths of bed rest are required after the operation, whereby physiotherapeutic exercises should be carried out to build up and maintain the muscles even if the patient is on bed rest for a long time. Physiotherapy plays an important role in the healing process.
