Announcer: Access to our experts with in-depth information about the biggest health issues facing you today. The Specialists with Dr. Tom Miller is on The Scope. Miller: Hi, I'm Dr. Tom Miller and I'm here with Dr. David Rothberg. He's an orthopedic surgeon and specializes in trauma care. David, how would one know if they had a pelvic fracture? Now I know that these are fractures that don't just occur spontaneously.
Generally, people will have some type of trauma. Tell us a little bit about how that happens. How does one suffer a traumatic pelvic fracture? Rothberg: There really are two separate patient populations that will have a pelvic fracture. The most common pelvic fracture is towards the front the pubic bones , which occurs in older patients.
These fractures are usually due to some thinning of the bones from osteoporosis. A common scenario is a patient loses his or her balance, lands awkwardly and breaks his or her pelvis. It is also possible for patients to lose their balance and cause their muscles to pull so hard against each other that they can pull the pelvis apart. Most pelvic fractures heal on their own. The local tissues in the area of the fracture frequently keep the fracture pieces in order and the bones heal with a little rest and good nutrition.
A stable pelvic fracture is almost always painful. Pain in the hip or groin is usual and is made worse by moving the hip or trying to walk - although walking may still be possible. Some patients find if they try to keep one hip or knee bent this can ease the pain.
There may also be visible signs of bleeding. Bleeding can track out to the skin in several places, some of which are more likely to be visible than others. They include:. Major and unstable pelvic fractures are likely to cause severe pain and shock. Pain may be in the pelvis, groin, back, tummy abdomen , or down the legs. The pelvic bones are large and have a rich blood supply, so when broken they will bleed heavily and the bleeding will not stop quickly.
Whilst the blood may not be visible, because it is on the inside of your tummy, this level of blood loss will cause a sudden drop in your blood pressure. Affected people will be pale, clammy and seriously unwell, perhaps even unconscious. It is sometimes possible to move around and attempt to walk immediately after a major unstable pelvic fracture - particularly after road accidents.
This is because shock can initially prevent you from feeling pain. Pelvic avulsion fractures are mainly seen in young, active sportspeople who are still growing. Symptoms are usually of sudden pain during a sudden powerful movement. The pain is often in the bottom, in the crease of the buttock, or at the bony part on the front of the hip. Afterwards the athlete will feel weakness and pain when doing the movements which use the affected tendon and muscle. Bruising and swelling are likely. Stress fractures - where there is a fine crack in the bone which does not extend all the way through - are one of the mildest sorts of stable fracture.
Stress fractures of the pelvis are easy to miss as the pain may be quite hard to locate. Symptoms typically consist of a dull pain that is difficult to localise at first. This may get better as exercise continues but be worse afterwards. In the case of major injuries, such as road traffic accidents, where pelvic fracture is likely and must be excluded, X-rays will be performed urgently to assess the state of the pelvic bones. A pelvic fracture is also suspected if you have had a lesser injury but there is pelvic bone tenderness, difficulty walking or any loss of sensation in the lower part of the body.
X-ray will show most pelvic bone injuries, although it will not show details of injuries to organs inside the pelvis. X-rays provide images of bones and in the case of the pelvis, they are usually taken from a number of different angles, so that doctors can check whether and how much the bones are out of line.
A computerised tomography CT scan involves multiple X-rays in 'slices' down through the pelvis in order to build up a three-dimensional image of the injuries. This will be done in complicated cases to get a better picture of the fractures and to look for associated injuries. A magnetic resonance image MRI scan is an alternative to CT and may give a clearer picture of damage.
This is not usually necessary, except in the case of stress fractures, which can show up well on MRI scanning but which commonly are not visible on X-ray or CT.
Ultrasound scans and contrast studies where a radioactive dye is injected to create pictures to enable doctors to check on internal organs and structures may be needed to assess internal organs. Radioisotope bone scans are sometimes used to look for stress fractures, particularly in patients who cannot have an MRI scan for example, if they have a pacemaker. If your fracture happened unusually easily, and your doctor thinks there is a possibility that you have underlying 'thinning' of the bones osteoporosis , you may be offered a bone scan to check your bone density.
Other investigations may include blood tests to assess the degree of blood loss and the function of the liver and kidneys, and testing of the urine to look for damage to the bladder. If you have an unstable pelvic fracture the treatment will depend on the location of the fractures, and on any other injuries you might also have.
The main aims of treatment of an unstable pelvic fracture are first to stabilise the pelvis and prevent further blood loss, then to keep the bones still to allow healing. Until help arrives a person with a suspected pelvic fracture should be covered with a blanket or jacket and should not be moved by non-trained personnel, especially if there is severe pain. If you are at a serious road accident and a person is walking around, get them to sit still.
Ask if there is any pain anywhere, particularly in their chest, tummy abdomen or hips. If there is pain anywhere near the pelvis they could have a major pelvic fracture, and you should assume they are seriously injured and keep them still and warm until emergency services arrive. It is well known that sometimes people walk around with severe pelvic fractures immediately after road accidents, as shock can prevent them from initially feeling much pain. Grade A: Stable fracture — usually relatively minor fractures, including avulsion fractures such a Rectus Femoris avulsion, and fractures of one of the Ilia.
Grade B: Rotationally unstable — compression fractures, often with separation of the pubic symphysis and widening of the SI joints. Grade C: Vertically and rotationally unstable — pelvis ring is completely disrupted. These injuries are extremely severe, often with multiple complications and a high fatality rate.
All forms of pelvic fracture should be treated with a rehabilitation programme to regain full movement and strength. This may begin quite early in the treatment process for minor injuries, with simple exercises such as contracting muscles and moving the legs. A Physiotherapist or Physical Therapist will usually advise you on this and demonstrate appropriate exercises. A pelvic avulsion fracture is where the tendon comes away from the bone, often taking a piece of bone with it.
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