Diagnosis

The diagnosis of a pelvic fracture involves both physical and instrumental examination methods. Often the description of the accident or fall that led to the pain or restriction of movement can be a guide for the diagnosis. It is important to feel the pulses, test the sensitivity and motor functions of the pelvis and legs to rule out damage to the blood vessels and nerves.

In addition, it is important to monitor blood pressure and determine the so-called Hb value (haemoglobin) in the blood if there is a suspicion of bleeding into the pelvis. A value of less than 8 mg/dl should be considered critical. In the event of a pelvic fracture due to polytrauma, up to 4 litres of blood can bleed into the pelvis, which poses a great danger to the patient’s life.

It is possible that swellings can be palpated by physical examination or, depending on the severity of the fracture, an asymmetry of the pelvis or a shifting of the bones against each other can be observed. If a pelvic fracture is suspected, a rectal examination should always be carried out, and in women an additional vaginal examination should follow. In order to be able to assess the extent of the injury and to exclude a pure contusion, a pelvic overview x-ray is taken.

This allows a possible fracture to be identified. In order to rule out further injuries, ultrasound and computer-tomographic (CT) images are also taken. These serve primarily to rule out injury to the internal organs.

The ultrasound examination looks for fluid in the abdominal cavity and for air in order to assess the severity of the injury. A so-called excretory urography should be performed if there are indications of an injury to the urinary tract. Older people in particular are affected by a fractured pelvis.

Their bones are usually already weaker and more susceptible to fracture. The reason for this is osteoporosis, which is not uncommon in old age and especially in women. (Osteoporosis is a degeneration of the bones.)

In patients with osteoporosis, minor traumas such as falls are sufficient to lead to a pelvic fracture, whereas a young adult would not have sustained an injury. Firstly, patients with osteoporosis are more prone to pelvic fractures and secondly, healing is more difficult and correspondingly longer. The therapy varies considerably depending on the extent and severity of the pelvic fracture.

If the fracture is incomplete and stable, surgery is usually not necessary. The pelvis only needs to be immobilised and relieved for some time (approx. 2-4 weeks).

This means lying most of the time and using walking aids when walking. Sometimes special bandages are used to stabilize the pelvis from the outside. It is also important to start physiotherapy again as soon as possible after the rest period, so that the muscles do not break down too much and movement restrictions are eliminated.

It is also important that patients who are in pain receive sufficient pain medication. Physiotherapy plays an important role in healing. In contrast, a complete, unstable fracture almost always requires surgery.

In an emergency, haemostasis is achieved by stabilisation from the outside using “pelvic clamps”. Particularly important in the case of a pelvic fracture is the constant monitoring of blood pressure and pulse, as this type of injury can lead to massive bleeding from large vessels and both blood pressure and pulse can be signs of circulatory failure due to blood loss. Especially the blood vessels from the area supplied by the femoral vein and femoral artery can cause such massive bleeding.

If there has been massive blood loss, emergency care must first be provided. Here, the blood loss must be compensated by giving the patient fluid, blood transfusions and, for example, coagulation factors. Then, in a second step, the fractions are screwed/plated.

The operation is often followed by a longer bed rest than in the case of a stable pelvic fracture. Due to the proximity of the pelvic bones to the internal organs, a complication can always occur in the form of injury. Important here are possible bladder and urethra injuries, but also injuries to the intestines or the internal genitals.

Since polytrauma is the primary cause of a pelvic fracture in younger people, the treatment of further injuries is just as important and decisive for the patient’s recovery. The typical surgical risks such as wound infection, post-operative bleeding or wound healing disorders must of course also be considered. The risk of thrombosis is extremely high in the case of a pelvic fracture, so that thrombosis prophylaxis must always be carried out.

It must also be taken into account that nerves running in the area of the operation can be damaged. In contrast, a complete, unstable fracture almost always requires surgery. In an emergency, haemostasis is achieved by stabilisation from the outside using “pelvic clamps”.

Particularly important in the case of a pelvic fracture is the constant monitoring of blood pressure and pulse, as this type of injury can cause massive bleeding from large vessels and both blood pressure and pulse can be signs of circulatory failure due to blood loss. Especially the blood vessels from the area supplied by the femoral vein and femoral artery can cause such massive bleeding. If there has been massive blood loss, emergency care must first be provided.

Here, the blood loss must be compensated by giving the patient fluid, blood transfusions and, for example, coagulation factors. Then, in a second step, the fractions are screwed/plated. The operation is often followed by a longer bed rest than in the case of a stable pelvic fracture.

Due to the proximity of the pelvic bones to the internal organs, a complication can always occur in the form of injury. Important here are possible bladder and urethra injuries, but also injuries to the intestines or the internal genitals. Since polytrauma is the primary cause of a pelvic fracture in younger people, the treatment of further injuries is just as important and decisive for the patient’s recovery.

The typical surgical risks such as wound infection, post-operative bleeding or wound healing disorders must of course also be considered. The risk of thrombosis is extremely high in the case of a pelvic fracture, so that thrombosis prophylaxis must always be carried out. It must also be taken into account that nerves running in the surgical area can be damaged.

Whether a pelvic fracture is treated conservatively or surgically depends on the severity of the injury. If it is an unstable pelvic injury of type B or C, surgery is indicated. Since a complicated pelvic fracture can cause great blood loss, the patient’s circulation is first stabilized before the actual operation to treat the fracture is performed.

First the injured blood vessels are treated and the pelvis is stabilised with a so-called external fixator (a stabilisation system that is inserted into the bone through the skin) or a pelvic clamp. In the actual operation to treat the pelvic fracture, the fragments are either screwed together or connected and stabilized with plates. The metal parts inserted into the body, such as screws or plates, usually remain in the body so that no second operation is necessary.

The entire procedure takes place under general anesthesia. After the operation, the patient must remain in bed for a few weeks. Physiotherapy is also very important for healing after the operation.