Diseases

Anatomy

The bony pelvis consists of the sacrum, coccyx and the left & right hemipelvis (including ilium, ischium and pubis). It is a hard structure that protects the viscera (i.e. bladder, large bowel, vagina, uterus and ovaries), connects the spine to the lower limbs and transfers body weight. It is the strong ligaments and tension of the pelvic floor that account for pelvic stability and the inner wall of the pelvic girdle is full of blood vessels and nerves. As such, serious pelvic fracture can produce significant internal bleeding and nerve damage.

Treatments

Orthopaedic surgeons will perform thorough physical examination to see if there are traumas in other parts of the body (skull, chest, abdomen and spine). Cleaning is required for any wounds and antibiotics will be prescribed to prevent infection. Further investigations will further include X-ray and Computed Tomography Scan(CT). If severe internal bleeding is suspected or shock has occurred, it is essential to rule out other possibilities; such as internal bleeding in the chest and abdomen. Should pelvic fracture be the main cause of internal bleeding, orthopaedic surgeons will apply an external fixator to reduce and immobilize the fracture site. Blood transfusion will be given in advance to stablise the blood pressure. If instability of blood pressure and shock persists, arterial embolization can be used to stop bleeding; under critical condition, orthopaedic surgeons will consider open surgery for bleeding control. Death rate due to pelvic fracture can be as high as 50%.

If there are no wounds or shock and there is only hip joint dislocation, reduction should be commenced immediately to ease pain and prevent sciatic nerve being compressed. Sometimes metal pin will be inserted to the tibia for temporary traction. Orthopaedic surgeons will prescribe painkillers and assess the fracture condition before surgery using X-ray and CT scan. If the fracture or hip joint is minimally displaced, non-surgical treatment is adopted. Patients need to stay in bed for one to two weeks and should impose no stress on the affected limb for three months, by using a crutch to help walking. If displacement of the fractured pelvis is not properly treated, leg length inequality and chronic hip & back pain might occur. Surgical treatment is the common option here, which will usually be performed within five days of injury. Rehabilitation process is similar after conservative and operative treatment.

Surgical treatments

Bone plates and screws are the most common surgical devices. The surgery starts with reduction of the fracture site, using bone plates and screws to stabilise the affected bone; in comminuted fracture, bone graft procedure is needed. Casting is usually not necessary after surgery and patients can start physiotherapy in two to three days. A special motion machine will be used to facilitate mobilization of lower limbs in bed. The affected limb should be kept not weight bearing for 12 weeks and a crutch will be used to help walking. Unless otherwise required, bone plates and screws do not need removal. There are two common surgical approaches; i.e. anterior and posterior access, each has its advantages and risks. In certain type of pelvic fracture cases, application of minimally invasive surgery under computer assisted navigation can minimize trauma to patients.