Fractures of the pelvis

• Published in: Journal of bone and joint surgery. British volume Vol. 92; no. 11; pp. 1481 - 1488
• Main Authors: GUTHRIE, H. C, OWENS, R. W, BIRCHER, M. D
• Format: Journal Article
• Language: English
• Published: London British Editorial Society of Bone and Joint Surgery 01.11.2010
• Subjects: Biological and medical sciences; Diseases of the osteoarticular system; External Fixators; Fracture Fixation, Internal - instrumentation; Fracture Fixation, Internal - methods; Fractures, Bone - surgery; Humans; Injuries of the limb. Injuries of the spine; Medical sciences; Orthopedic surgery; Pelvic Bones - injuries; Pelvic Bones - surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Traumas. Diseases due to physical agents; Treatment Outcome; Orthopedic surgery; Treatment; Diseases of the osteoarticular system; Hip bone; Fracture; Pelvis bone; Trauma
• DOI: 10.1302/0301-620X.92B11.25911
• ISSN: 0301-620X

High energy fractures of the pelvis are a challenging problem both in the immediate post-injury phase and later when definitive fixation is undertaken. No single management algorithm can be applied because of associated injuries and the wide variety of trauma systems that have evolved around the world. Initial management is aimed at saving life and this is most likely to be achieved with an approach that seeks to identify and treat life-threatening injuries in order of priority. Early mortality after a pelvic fracture is most commonly due to major haemorrhage or catastrophic brain injury. In this article we review the role of pelvic binders, angiographic embolisation, pelvic packing, early internal fixation and blood transfusion with regard to controlling haemorrhage. Definitive fixation seeks to prevent deformity and reduce complications. We believe this should be undertaken by specialist surgeons in a hospital resourced, equipped and staffed to manage the whole spectrum of major trauma. We describe the most common modes of internal fixation by injury type and review the factors that influence delayed mortality, adverse functional outcome, sexual dysfunction and venous thromboembolism.