A pelvic fracture, medically pelvic fracture, is an injury to the bony pelvic ring apparatus inflicted by external force. Pelvic fractures are usually easily treatable with adequate treatment measures and have a good prognosis.
What is a pelvic fracture?
A pelvic fracture occurs when parts of the bony apparatus of the pelvis are damaged. The human pelvic apparatus includes the vanes of the ilium, the pubic bone (anterior part) and ischium (lower part), and the sacrum, which closes the pelvis in the posterior part and supports the spine. These elements of the bony apparatus form a coherent pelvic ring that protects the internal organs. In the case of a pelvic fracture, this protective pelvic ring is damaged by a break, whereby a differentiation is made between unstable and stable pelvic fractures. While in a more common stable pelvic fracture, the pelvic ring is preserved despite a fracture, usually of the pubic or iliac bone, in an unstable fracture the ring union is broken. In addition, in an unstable pelvic fracture, internal organs may be affected.
Causes
Stable pelvic fractures are most often caused by a fall (for example, due to black ice). In particular, older people who already suffer from age-related osteoporosis (decalcification of the bones, bone loss) are at risk due to the instability of their bone apparatus. Therefore, additional injuries (usually femoral neck fracture) often occur in combination with a pelvic fracture in elderly patients. Unstable pelvic fractures are in most cases caused by severe externally inflicted trauma, such as car accidents or falls from great heights, and not infrequently involve several bones of the pelvic ring (polytrauma). In many cases, internal organs such as the bladder, bowel area, vessels, or nerves are also injured, and pelvic fractures involving the bladder are particularly dangerous.
Symptoms, complaints and signs
A typical symptom that may indicate a pelvic fracture is severe pain in the pelvic region, sometimes swelling is seen at the fracture site or bruising. An unstable fracture usually causes more pain than a stable one. Therefore, a stable fracture is sometimes not even perceived as a fracture at first. The fracture causes an unstable feeling throughout the pelvis, possibly resulting in a pelvic tilt and a difference in leg length. If internal organs that the pelvis is normally designed to protect are also injured in the fracture, genital or anal bleeding may occur, especially if the bladder, bowel, or internal sex organs are injured. If nerves are injured or affected by the fracture, sensory disturbances or problems with motor function may also occur. Most often, a pelvic fracture also causes limited movement in the legs. In worse cases, if internal organs were injured in the fracture, sufferers may become pale in the face, have an accelerated pulse, suffer from internal agitation, or perhaps even lose consciousness. If these symptoms occur in connection with a fall, a doctor should be called immediately.
Diagnosis and course
A pelvic fracture is diagnosed based on characteristic symptoms such as pain, swelling, and any lack of stability of the pelvic ring, discoloration, or misalignment and blockage of the hip joint during a physical examination. In some cases, a pelvic fracture may cause the pelvic bones to be slightly displaced from each other. Differentially, stable pelvic fractures can be distinguished from unstable ones by the less pronounced pain. Bloody urine may indicate involvement of the bladder, urethra, and/or ureter. The diagnosis is confirmed by an X-ray examination, which provides information about the location and course of the pelvic fracture, and by imaging procedures (sonography, computer tomography), which can be used to determine whether the internal organs have been injured. The course and prognosis depend on the extent of the pelvic fracture as well as any present involvement of the internal organs. As a rule, pelvic fractures are readily curable with appropriate therapeutic measures.
Complications
Various complications can occur as a result of a pelvic fracture.The fracture can, for example, injure the veins or cause damage to the bladder, urethra, vagina or anus. Nerve damage and temporary paralysis are also common consequences of a pelvic fracture. Among the most common and also most dangerous complications are bleeding, which is often exacerbated by anti-inflammatory drugs. In addition, diaphragmatic ruptures, muscle injuries and venous thrombosis can occur. If the fracture is an acetabular fracture, there are often additional problems such as post-traumatic osteoarthritis or heterotropic ossification. Particularly intense trauma can lead to death of the distal head of the femur. In the aftermath of a fracture, there may also be muscle atrophy, weight gain, and other secondary problems, although these can be prevented with adequate therapy. During the treatment of a pelvic fracture, complications such as wound healing disorders, bleeding and infections mainly occur. Rarely, a fracture of the pelvis leads to incontinence and impairment of sexual functions. By constant consultation with the physician and an observation of the body’s warning signals, complications resulting from a pelvic fracture can almost always be avoided.
When should you see a doctor?
If you have a pelvic fracture, see a doctor immediately. In acute emergencies or directly after an accident or after an injury, the hospital can also be visited in this case or the emergency doctor can also be called directly. This can prevent further and irreversible consequential damage. If a doctor is not consulted, complaints may arise when the bones grow together. A doctor must therefore be consulted above all if a bone fracture is clearly visible and if the affected areas on the body are severely swollen. It is not uncommon for patients to suffer from severe pain and bruising. Furthermore, bloody urine is also a clear sign of a pelvic fracture and should therefore be examined by a doctor. Patients are significantly restricted in their movement, so ideally they should not move themselves to avoid further damage. A doctor should also be consulted in any case if the affected person loses consciousness. Various complications can be avoided by prompt and early treatment.
Treatment and therapy
Stable pelvic fractures usually heal without complications or surgical intervention. However, a few days of bed rest followed by early mobilization under the guidance of a physical therapist is indicated. In the majority of cases, unstable pelvic fractures must first be fixed externally with a stabilizer (external fixator) or pelvic forceps to stabilize the pelvic ring and stop internal bleeding. After the bleeding has stopped, the pelvic ring can be opened in a surgical procedure and the loose fracture ends caused by the pelvic fracture can be fixed with screws or plates. The surgical procedure chosen depends to a large extent on the presence of other injuries. Following the surgical procedure, depending on the surgical method chosen, bed rest is indicated for two months, and passive mobilization measures with a physiotherapist should be started as early as possible. In rare cases, complications such as post-operative bleeding, wound healing disorders and infections may require additional treatment. In addition, if the nerves are involved, there may be long-term consequences such as incontinence or impairment of sexual functions in male sufferers of a pelvic fracture, which should be treated accordingly. Individuals affected by a pelvic fracture are usually able to withstand normal physical stress and perform everyday movements after successful completion of therapy.
Outlook and prognosis
In the case of a pelvic fracture, the prospects for recovery depend greatly on the extent of the injury. If the pelvic fracture is stable, chances are good that it will heal without complications and that no secondary damage will remain. Even an unstable pelvic fracture can heal well if it is treated properly. Problems with wound healing, secondary bleeding and infections rarely occur. Occasionally, nerves supplying the bladder and bowel can be affected, which can lead to incontinence problems; in men, sexual functioning can also be restricted as a result.However, the prognosis depends not only on the degree of injury but also on how old a patient is, his state of health and the location of the fracture. The healing time for a stable pelvic fracture is approximately between 4 and 8 weeks. However, pain may still occur after this time. To promote healing, bed rest should be strictly followed for the first few weeks. Patients cannot avoid surgery for a complete pelvic fracture, especially if the hip joint is also affected. Bed rest is also required after surgery, and in the case of a complicated pelvic fracture, it may even take several months before the legs are allowed to bear weight again.
Prevention
A pelvic fracture can be prevented by taking appropriate precautions to protect against falls. Elderly people who are particularly at risk from age-related osteoporosis and who already have impaired mobility should use walking aids such as rollators and sturdy footwear for a safe gait to protect against pelvic fractures.
Here’s what you can do yourself
A pelvic fracture usually requires surgery. Only in the case of a stable type A pelvic injury can the fracture be treated independently with bed rest and mobility exercises. Together with a physical therapist, healing of the fracture can also be achieved entirely without surgical intervention. A type B or type C pelvic injury must be healed under the supervision of a physician. Accompanying this, healing can be accelerated by some self-measures and home remedies. In the first days after the injury, stimulants such as nicotine and alcohol should be avoided. By taking it easy, a quick healing of the fracture can be achieved. After a few days to weeks, bone regeneration can be promoted by light sports and yoga. Above all, the surrounding joints should be used again in everyday life as soon as possible to avoid further bone and muscle loss. A proven natural remedy for bone fractures is blackroot. The plant strengthens the injured bone and can be applied either as a compress or paste. In general, a diet rich in minerals is recommended for bone fractures. Suitable foods include milk and dairy products, as well as unsalted dried fruit, figs, garlic, onions or bananas. Magnesium and potassium can be supplied to the body through oatmeal, asparagus, legumes or prunes, for example.
