Pelvic Fractures

 

The pelvis is an irregularly shaped bone that spans between the spine and lower extremities. Pelvic fractures are usually the result of high energy trauma such as car accidents but can occur from ground level falls in older individuals with softer bones. There are two main types of pelvic bone fractures: Acetabulum or hip socket fractures and pelvic ring fractures.  These are highly complex injuries that required a trained specialist in order to fully evaluate and manage.

  I have specialized fellowship training in the surgical management of displaced or unstable pelvic ring and acetabulum fractures and treat approximately 75 surgical cases per year.  Many of these patients are transferred in from outside hospitals that do not have a surgeon who performs pelvic fracture surgery. 

 

Acetabular Fractures

 

High Energy Pelvic Ring Fractures

 

Low Energy Pelvic Ring Fractures

 

 

Diagram of an intact pelvis

 

 

 I believe there are several factors that are important when patients, or more commonly their families, are faced with making a decision about finding a surgeon to treat their injury. The first is experience of the surgeon performing the operation.  Questions that you might wish to ask the surgeon are: How many of these procedures have you done? How many do you do per year?  Do you have specialized (fellowship) training in pelvic fracture surgery?  Most of these cases are difficult to perform well and I would recommend the surgery be performed by a surgeon with experience in treating these injuries.

 

 

Widely displaced pelvic ring fracture/dislocation

 

The second factor is the ability of the instiution to take care of the multiply injured patient. Most pelvic fractures do not happen in isolation but are one of several injuries incurred by the patient. These injuries often require a team of physicians, nurses, therapists and social workers who help manage all aspect of care. I practice at a regional trauma center with a dedicated trauma ICU and trauma team caring for a high volume of multiply injured patients. In addition, we use specialized operating room equipment and tables that are a necessity in treating these injuries properly. Although many community hospitals have nicer rooms and more comfortable and accessible settings, they are often ill-equipped to care for multiply injured patients. In the long run, this leads to sub-optimal clinical outcomes and higher complication rates.

 

 

Displaced "transverse" acetabular fracture

 

 

  The final factor is timeliness of transfer.  In most cases the first day or so in spent on "resuscitation" in which life threating issues are addressed and fluids and blood are replenished in an ICU setting. There is a "window" of opportunity to surgically manage these injuries withing the first 3-4 days after injury.  After this a systemic inflammatory condition ensues which generally makes repair risky for the next 4-6 days.  The best outcomes are obtained If the transfer can occur quickly and definative care is performed early, whereas delaying definative treatemnt beyond 14 days leads to markedly worse outcomes.  I am able to have most patients transferred within 24 hours and often within 8 hours if their condition has been stabilized.  This allows me to definatively repair most fractures before the 3-4 day "window" closes.

 

 

3D CT scan of a "both column" acetabular fracture