Unstable Pelvic ring injury before repair

Pelvic Fractures: High Energy

High Energy Pelvic ring injuries result from injuries such as high speed motor vehicle collisions, motorcycle accidents and falls. Displaced fractures in patients with strong bone are potentially devastating injuries. They rarely occur in isolation and are often associated with other fractures and injuries. Initial management includes assessment of the mechanism of injury and fracture pattern and whether urgent intervention is required. Most pelvic ring fractures are mechanically stable, meaning that they don’t move or displace when the patient moves or shifts. Although painful, these types of fractures do not require surgical intervention and heal spontaneously.      

   Unstable pelvic ring fractures are surgical emergencies and require some type of initial intervention such as a pelvic binder or external fixator to keep the fracture segments from moving. Definitive management of unstable fractures requires surgery which should be performed by an experienced surgeon with fellowship training in the management of pelvic fractures. These patients are often transferred to institutions with specialists who have expertise and training in management of these types of injuries. My institution has a dedicated trauma ICU and trauma team with physicians, nurses, therapists and social workers to help care for all aspects of multiply injured patients with pelvic ring fractures.  This is one of the single most important aspects of achieving a good outcome and I stress to patients, or more commonly a patients' family members, that it is critical that the treating physician (be that another surgeon or myself) have this type of team support and that the hospital have the capability to treat multiply injured patients.  Surgical repair can be performed with a minimally invasive technique in about half of all cases, with a formal open reduction required in the other half. 

   The greatest risk with types of injuries are an increased propensity for blood clots in the veins of the legs and pelvis, which can be a potentially life threatening.  Recovery from pelvic ring fractures is slow and full recovery often takes about 1 year.  The best outcomes are seen in those patients with early stabilization of the fracture and accurate restoration of the bony architecture of the pelvic ring.

Unstable Pelvic Ring Fracture After Repair