24. Pelvic fracture

Essay 24- Fracture of pelvis

• Classification
• Isolated
• Partially interrupting
• Completely interrupting

Isolated fractures without interruption of the pelvic ring:

• Avulsion fractures;
• Fractures of the iliac crests;
• Isolated fractures of the sacrum;
• Fractures of the coccyx.

Injuries, interrupting the pelvic ring:

• Injuries, caused by antero-posterior compression with three subgroups;
• Lateral compression injuries, also further divided into three subgroups;
• Injuries of vertical shear;
• Combined unstable injuries.

• Etiology
• Direct trauma over an isolated area of the pelvis
• Rapid sudden muscular contractions
• High energy trauma leading to rupture of pelvic ring
• Basic mechanisms
• Antero-posterior compression- pubic symphysis is torn or the pubic bones fracture
• Lateral compression- due to lateral fall, impacts from side or compression of both sides of pelvis
• Leads to fractures of the pubic and the ischiadic bones!
• Vertical stress- fall from height over the legs or pelvis
• Typical feature of vertical dislocation of the hemipelvis!
• Tests to locate pain
• Erikson test- pressing of both iliac crests in a backward direction
• Larrey’s sign- external rotational pressure on the pelvic halves!
• Direct compression of pubic symphysis with a fist