Introduction

The pelvic fracture can be divided into different types depending on its severity. One possibility of classification is the ABC classification according to AO (Arbeitsgemeinschaft Osteosynthesefragen). Pelvic fractures are classified as type A, B and C according to the criteria of pelvic stability and the flow of force from the spinal column to the hip joints.

In type A, the pelvic ring is stable and is not completely broken at any point, but only torn. The flow of force from the spine to the hip joints is still intact. This type of fracture mainly involves fractures or tears in the marginal area.

The type B pelvic fracture is rotationally unstable, as it results in a complete fracture of the anterior part of the pelvic ring. The posterior part is stable. This fracture type also includes the so-called “open-book fracture”.

This involves a complete severance of the symphyseal ligaments, as well as the anterior ligament portion of the iliac/ sacroiliac joint. On the affected side, the pelvis can then be opened like a book, hence the name “open-book”. Even with this type of fracture, the flow of force from the spine to the hip joints is still stable.

The type C pelvic fracture is completely unstable because the injury affects both the anterior and posterior pelvic rings. This fracture type represents the most serious fracture of the pelvis. It is important to know at which point the posterior pelvic ring was severed.

There are several possibilities for this: either by fracturing the sacrum or the ilium or by blasting the sacroiliac joint (i.e. the joint between the ilium and the sacrum). Fractures of the sacrum are additionally classified according to Denis. The location of the fracture is of great importance with regard to the nerve damage to be expected. A central fracture of the sacrum often results in multiple nerve damage. In this type of fracture, however, the flow of force from the spinal column to the hip joints is interrupted.

Symptoms

The main symptom of a pelvic fracture is severe pain in the area of the pelvis. Swelling can occur above the fracture area. It is possible that so-called bounce marks or even bruises can be seen at the site of the injury.

The patient may be able to move his or her leg only to a limited extent or possibly only in pain. In addition, a pelvic obliquity or a difference in leg length may be caused by a fracture of the pelvis. If the internal organs, which are normally protected by the pelvis, are also involved, bleeding from the genitals or anus may occur. Especially the bladder, the intestine, and the internal genitals can be affected by an injury to the pelvis. If the nerves running through the pelvis are also involved, this may also lead to sensitivity disorders (sensitivity disorders) or even motor disorders.