MINORS MANUAL
Pelvic fractures are serious injuries that affect the bony structure forming the base of the axial skeleton, connecting the spine to the lower limbs.
These fractures are often caused by high-energy trauma, such as car accidents or falls from height, although they can also occur in the elderly due to minor falls, often linked to osteoporosis.
Given the proximity of major blood vessels and vital organs (bladder, urethra, intestines), these fractures carry a high risk of haemorrhage, visceral injury, and other severe complications.
Diagnosis
Diagnosis is based on a clinical history of significant trauma and clinical signs of pelvic instability, severe pain, deformity, or inability to walk. Initial evaluation includes anteroposterior pelvic X-rays, and in many cases, a computed tomography (CT) scan to identify complex or displaced fractures and assess for visceral injuries or internal bleeding.
Differential Diagnosis
Pathology | Key Characteristics |
|---|---|
Pelvic contusion | Pelvic pain with no visible fracture on imaging |
Hip dislocation | Severe pain, deformity, limb in internal or external rotation |
Acetabular fracture | Hip pain, limited movement, often associated with pelvic fractures |
Bladder or urethral rupture | Haematuria, inability to urinate, suprapubic pain |
Emergency Management
Initial airway, breathing, and circulation (ABC) assessment: In patients with severe trauma, ensure a rapid and appropriate initial assessment. Haemorrhage control is crucial.
Pelvic immobilisation: Apply a pelvic binder or stabilising device to reduce internal bleeding and stabilise the pelvis. This is critical, as pelvic fractures can cause significant haemorrhage.
Haemorrhage control: Pelvic fractures are a major cause of massive bleeding. In cases of haemodynamic instability, consider blood transfusions and angiography with embolisation to control haemorrhage.
Evaluation of associated injuries: Look for signs of urethral or bladder injury (e.g., haematuria, perineal bleeding, difficulty urinating) and assess neurological and vascular stability in the lower limbs.
Diagnostic imaging: Request an anteroposterior pelvic X-ray and, in complex cases, a CT scan for a more detailed evaluation of the fractures.
Analgesics and stabilisation: Administer appropriate analgesia for severe pain. Keep the patient immobilised until definitive management is determined.
Thromboembolic prophylaxis: Due to the high risk of thrombosis with pelvic fractures, start prophylactic measures (heparin or compression devices) if there are no contraindications due to bleeding.
Definitive Treatment
Definitive treatment depends on the severity and type of fracture. Stable fractures can be managed conservatively with bed rest and pain management, while unstable or displaced fractures require surgical intervention.
Surgical management may involve open reduction and internal fixation (ORIF) to stabilise bone fragments and restore pelvic anatomy.
In cases of uncontrolled haemorrhage, emergency interventions like angiographic embolisation or external fixation may be necessary. Rehabilitation is crucial for long-term functional recovery.
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