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What is pelvis fracture treatment?

Treatment for pelvis fracture can take a variety of forms. The pelvis is the ring of bones at the base of the spine; it creates a basin-like structure that encloses many vital organs, including the bladder, portions of the bowel and reproductive organs. Pelvis fracture is a complete or partial break in one of the bones that make up the pelvic ring: the sacrum (the triangular bone at the base of the spine), coccyx (tailbone) and hip bones.

Most pelvic fractures are caused by high-energy traumatic injuries, such as those incurred in a car accident. These may involve damage to organs, blood vessels and nerves, and are likely to require urgent and extensive treatment, including surgery. In some cases, a low-energy accident, such as a minor fall, may result in a pelvic fracture; this is most likely to occur in a person whose bones have been weakened by osteoporosis. A low-energy pelvic fracture may not require surgery.

A pelvic fracture may be stable, in which the broken bones remain in alignment, or unstable, in which the broken bones have moved out of alignment (another term for this is displacement). Low-energy pelvic fractures are more likely to be stable, while high-energy fractures are frequently unstable.

The best approach for your pelvis fracture will depend on a number of factors, including your age and medical history, and the type, location and severity of the break or breaks.

Types of pelvis fracture treatments

Nonsurgical treatment

If the pelvis fracture is stable, with minimal or no displacement of the broken bones ,it may be possible to treat it without surgery. If a nonsurgical approach is appropriate, treatment may consist largely of avoiding weight bearing on your legs while the fracture heals. You may need to use crutches or a walker, or a wheelchair if you have fractures above both legs. Because the injury and reduced activity raise your risk of blood clots, your doctor may prescribe an anticoagulant (blood thinner).

Surgery

If the pelvis fracture is unstable, you are likely to require surgery. The goal of most pelvis fracture surgeries is to reposition the broken bones and stabilize them so that they remain aligned during healing. Most pelvis fractures are surgically treated in one of the following ways:

  • Metal plates and screws—This is the most common surgery for pelvic fracture. The bones are moved back into alignment, and kept in position by screws or a metal plate attached to the outer surface of the bone.
  • External fixation—Pins or screws are placed through small incisions in the skin and muscle into the bone. These pins or screws are attached to a frame of carbon fiber rods outside the skin; this external frame holds the holds the pins or screws in position to stabilize the fracture. External fixation may be the only treatment needed to stabilize the bones as they heal or may be used as a temporary measure until the patient can tolerate surgery.
  • Pins—In cases where the fracture occurs close to the thighbone, pins may be used to hold the joint in place. This approach is most often used for younger patients, whose bones are still growing and do not require the extra stability provided by plates and screws, which can limit proper growth.

What to expect

Because the pelvis protects important organs, blood vessels and nerves and anchors the muscles of the abdomen, hip and thigh, it is important to seek immediate medical attention if you believe you may have sustained a pelvic fracture. The doctor will perform a careful physical examination; in the case of a high-energy trauma, which may have caused extensive injury to a variety of systems, you may be attended by a number of medical specialists. To determine the proper treatment, you may need one or more imaging test:  

  • X-ray—This will likely be the first imaging test performed. X-rays provide a clear image of bone and will allow the doctor to identify the location and severity of the fracture. It is likely that a series of x-rays will be taken from different angles to help the doctor visualize any displacement, in which the ends of broken bones no longer line up properly.
  • Computed tomography scan (CT or CAT scan)—Depending on the complexity of the case, a CAT scan may also be required. This test uses a computer to combine X-ray images taken from multiple angles, producing a cross-sectional picture that offers great detail.
  • Ultrasound—An ultrasound uses sound waves to create images that can show internal bleeding that may have occurred during the fracture.
  • Urethrography—Because a pelvic fracture may be accompanied by damage to the bladder or urethra,  the doctor may order  a urethrogram. This is a radiological exam in which contrast material, which shows up on X-ray, is injected into the urethra to allow the doctor to visualize possible injury.
  • Arteriography—This is another common imaging test when pelvic fracture is suspected. As with urethrography, contrast material is injected, this time into the bloodstream, to aid the doctor in identifying possible internal bleeding.

Recovery

To reduce the risk of blood clots and other complications, it is likely that you will be encouraged to begin walking as soon as possible after surgery—however, you will need to use crutches, a walker or a wheelchair for a period of time in order to avoid weight bearing. Your doctor will probably also prescribe foot and leg exercises. Because your mobility will be restricted, your doctor may prescribe an anticoagulant (blood thinner) to reduce the risk of blood clots.

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