Pelvic Fractures

Pelvic fractures usually result from highenergy trauma and have a mortality rate of ~10%. The high mortality rate is a result of hemorrhage from large bleeding bony surfaces or disruption of the pelvic venous plexus. Arterial involvement, however, is seen in only 10% of all pelvic fractures. In addition, because of the high-energy trauma, pelvic fractures are frequently associated with intrapelvic and abdominal visceral trauma. Thus the workup and management of all pelvic fractures must be carried out in unison with the efforts of the entire trauma team.

The pelvic ring is made up of the sacrum and two innominate bones consisting of the ilium, ischium, and pubis. The innominate bones are joined anteriorly at the pubic symphysis and posteriorly to the sacrum at the sacroiliac joint. Transverse ligaments stabilize the symphysis pubis while the sacroiliac joint is stabilized by anterior and posterior ligaments. Disruption of a single element of the ring does not render the pelvis unstable. However, if several elements are injured the pelvis may become unstable.

The immediate goals of pelvic fracture management are hemodynamic stability, prevention of septic sequelae, and stabilization of the fracture to allow early patient mobility. Pelvic fractures can be classified into three main groups, stable, partially stable, and unstable, based on fracture pattern and associated soft tissue injury.