The pelvis is an important and complex bone with multiple parts. It is a ring structure made up of three bones that are joined together by very strong ligaments. The pelvis connects the spine to the legs, so it helps us walk upright and keeps our whole body connected and stable. In addition, many structures in our body are protected inside the pelvis, including our intestines, bladder, and sexual organs, as well as major arteries and nerves that connect the heart and spinal cord to the legs.
Mechanism and Epidemiology
Because the pelvis is such an important structure, it is inherently very strong. It takes a lot of energy to break the pelvis, so these fractures are generally caused by car and motorcycle crashes or falls from a height. Sometimes these injuries occur in older patients who have very poor bone quality (osteoporosis) and merely fall from standing. Because the pelvis is a ring, it breaks like a hard pretzel; almost always breaking in more than one place. Because of this, multiple parts of the pelvis may need surgery, or some parts may need surgery while others do not. Pelvis fractures can be dangerous because they may involve damage to other important structures nearby, such as major arteries, intestines, and bladder. Patients can bleed to death from some pelvis injuries, so it is very important that they are taken care of appropriately.
When a patient first comes into the emergency room following a trauma, standard treatment involves checking the "ABCs": airway, breathing, and circulation. Examining the pelvis by squeezing on it is part of the "C" for circulation. If there is any sign that your pelvis is not solid, you may be put in a wrap or binder to help keep the bones in the right place and decrease internal bleeding. Even with a wrap, you can still bleed if an artery has been injured, so you may need to go to the operating room or interventional radiology to help stop the bleeding.
If your pelvis is thought to be broken, you will have x-rays and/or a CT scan to help determine exactly what parts of your pelvis are broken and how to treat it. Depending on the type of injury, you may also need a traction pin placed in your leg to keep the pelvis fracture in the right position. For elderly patients with weak bones (osteoporosis), these fractures are sometimes not seen on x-ray immediately and may only be found using a CT or MRI scan.
Pelvis fractures may be treated with or without surgery. Fractures that have not gone all the way through the pelvis or that are due to osteoporosis may be able to heal without surgery. If you have a more severe fracture, you will need screws and/or plates placed in your pelvis. In general, if you are treated with surgery, you will need some amount of bedrest or time in a wheelchair before you are able to walk again.
If you have a pelvis fracture that is treated without surgery, you may be able to walk with crutches or a walker right away. If you have a have a more severe pelvis injury that requires surgery, you may be asked to not put weight on one or both legs. In this case, you must use crutches, a walker, or a wheelchair after surgery.
Due to the severity of pelvic ring injuries, about 75 percent of patients experience some long term issue. Such issues could include occasional low back or groin pain, nerve damage to the legs or genital area, problems with incontinence or difficulty going to the bathroom, or poor circulation to the legs. You may also have some difference in the length of your legs or a permanent limp.
If you are a woman who has experienced a pelvic ring injury and you want to become pregnant, make sure your gynecologist/birth team knows that you have injured your pelvis. A vaginal delivery may still be possible even if plates and screws are in your pelvis. This should be discussed with both your orthopaedic surgeon and your gynecologist/birth team.
- American Academy of Orthopaedic Surgeons
- American Association for the Surgery of Trauma
- Hughston Clinic
Anna N. Miller, MD
Edited by the OTA Patient Education Committee
X rays and images from the personal collection of Dr. Miller and Christopher Domes, MD