Pelvic injuries, fractures and traumas can be divided into fractures of the acetabulum, stable / unstable fractures of the pelvic ring and avulsion fractures.
Acetabular (hip joint cup) fractures in children and adults result from high velocity trauma such as hip dislocations or motor vehicle accidents. Low velocity trauma such as a fall out of bed onto the point of the hip may cause these fractures in elderly patients.
Management of these injuries is complex and depends on the location and displacement of the various fracture lines as determined by CT scan. Research shows that the only way to prevent rapid onset hip arthritis is to reduce any significantly displaced fragments. This may require surgical intervention.
Pelvic ring fractures may be devastating, life threatening injuries and any patient who has suffered high velocity trauma and has signs of a pelvic fracture requires emergency resuscitation and advanced trauma life support (ATLS) management. Life-threatening abdominal organ- and vascular injuries must be immediately managed by the general surgical team. Orthopaedic fixation is carried out once the swelling and other soft tissue injuries have healed.
One of the commonest injuries in elderly patients is a stable pelvic ring fracture involving the pubic rami (pelvic connection in the front) and/or the sacral bone (triangular bone at the back). These injuries almost never require surgery and must be differentiated from a hip fracture, which they may clinically resemble.
Avulsion (pull-off) fractures are common around the pelvis in adolescent- as well as mature athletes and they are caused by eccentric muscle contracture during athletic activity. While operative fixation may be required in adults, these fractures often heal spontaneously in growing children.
