Pelvic fractures

Abstract

Pelvic fractures are relatively uncommon injuries, but their incidence is rising within the trauma population. Their severity ranges from low-energy, stable injuries to high-energy and unstable patterns; and they continue to cause significant morbidity and mortality. The diagnostic and therapeutic modalities utilized depend on numerous factors including patients' characteristics and haemodynamic status, mechanism of injury and fracture pattern with associated pelvic instability, as well as the timing of presentation and treatment. Knowledge of the complex anatomy and biomechanics of the pelvic ring is essential and dictates the appropriate management. Pelvic surgery following a traumatic disruption of the pelvic ring can be divided into the acute stabilization phase and the delayed reconstruction phase. For unstable pelvic fractures with associated haemodynamic instability, acute management with provisional stabilization of the pelvis and haemorrhage control, with arterial embolization or pelvic packing, helps to reduce early mortality. The second phase of definite pelvic reconstruction and restoration of pelvic anatomy is performed when the patient is physiologically stable, usually within 3–7 days post-injury, aiming to reduce associated late complications and improve function. Besides the complexity of such treatment, pelvic fractures are also associated with a number of acute and chronic complications, including infection, iatrogenic nerve lesions, thromboembolic episodes and pelvic malunion/non-unions, leading to significant morbidity and long-term disabilities with significant impact on patients' quality of life and substantial socioeconomic implications. The management of pelvic fractures still remains a challenge even to the most experienced trauma surgeons and well-developed trauma care systems.