Management of Pelvic Fractures

Abstract

Injuries to the pelvic ring are relatively uncommon, with a prevalence of 20–37/100,000 of the general population [1], whereas, in the polytrauma patients, their prevalence rises to 20% [2]. Overall, pelvic fractures account for approximately 3% of all skeletal fractures [3]. These injuries range from low energy stable fractures to high energy unstable patterns. Enormous injury forces are required to cause an unstable pelvic injury, particularly in young patients. The magnitude of this force is associated with substantial soft tissue injuries. Furthermore, this force is usually applied to other parts of the body causing injuries to other organ systems. A pelvic fracture therefore reflects only a portion of the destructive energy sustained by the patient. It is important to understand that this injury is usually seen in the spectrum of polytrauma and must be considered as a potentially lethal injury. Indeed despite the improvements made in prevention of injury, pre-hospital care, the widespread use of the ATLS protocol and the advances made in intensive care medicine, the mortality rate following pelvic fractures remains high in the region of 15% [4]. Mortality usually is due to both the pelvic fracture hemorrhage and the associated injuries to the central nervous system and to the chest.