Pelvic Fracture

Fractures of the pelvis account only for about 0.3-6% of all fractures. A pelvic fracture can simply be described as a break in one or more bones comprising the pelvis. Pelvic fracture is a serious condition and requires immediate medical intervention.

• The worst pelvic fractures are caused by high-speed accidents such as car accidents or motorcycle accidents or falls from high places, which have major impact on the body. The greater the force, the more severe the fracture. Depending upon the direction and degree of the force, these injuries can be life threatening.
  
• Other injuries such as broken bones or damage to liver, kidneys or other organs.
  
• Pelvic fracture also occurs in people with osteoporosis.
  
• Pelvic fracture occurs among teens, involved in sports and athletic activities such as football, hockey, skiing and long distance running. These fractures occur with sudden muscle contractions.
  
• Pelvic fracture is usually caused by falls in elderly people, especially when getting out of a bathtub or descending stairs.

Symptoms of pelvic fracture include severe pain in the groin, hip or lower back area. The pain is bound to worsen when moving the legs. There may be pain in the abdomen and numbness and tingling sensation in the groin or legs. Bleeding from the vagina, urethra or rectum is often noticed with pelvic fractures. There may be difficulty in urinating and difficulty in walking or standing.

Types of Pelvic fractures

Stable or unstable pelvic fractures: In stable pelvic fracture, there is minimal hemorrhage. The break occurs in one point in the pelvic ring. In unstable pelvic fracture, the pelvis becomes unstable. The break occurs in two or more break points in the pelvic ring. There occurs moderate to severe hemorrhage.

Open or closed pelvic fractures: If open skin wound occurs during the fracture in the lower abdomen, it is called open pelvic fracture. If no skin wounds occur, then it is closed pelvic fracture.

Diagnostic tests such as x-rays, CT scans are used to diagnose pelvic fractures. MRI allow a detailed picture of the pelvic area. Abdominal ultrasound is used to find internal bleeding and other injuries within the abdomen. Urethrography may be conducted to check injuries in urethra by means of an injected dye. Arteriography, in which dye is injected in the arteries to check for internal bleeding within the pelvis, is sometimes used.

Treatment to the pelvic fracture depends upon the severity of the injury caused. A pelvic fracture is a serious injury. In some cases, it may be complicated with injuries in other parts of the body and severe shock as well. Sometimes severe internal and external bleeding and damage to the internal organs could occur. In these situations, immediate attempt is made by the emergency doctor to stop internal and external bleeding caused by the injury. In case of minor fracture, the treatment would merely consist of bed rest and painkillers.

Most of the times, surgery is undertaken to repair the pelvic fracture. Healing after surgery can take anywhere between few weeks to several months. Thus a lengthy rehabilitation becomes necessary after an extensive pelvic surgery.

Avulsion fracture

A fracture is called an avulsion fracture when the injury occurs in a place where a tendon or ligament that attaches to the bone pulls off a piece of the bone. It is common to notice avulsion fractures occur around the pelvis area, though they can occur anywhere in the body. More than adults, children are more prone to avulsion fracture, because a child's bone may give away before the ligament or tendon is injured whereas in adults, ligaments get injured more. Children have an area of bone that grows faster. This area in the skeleton is known as a growth plate. When an injury occurs in children near a growth plate, the tendons or ligaments can pull very hard and it will lead to a fracture of the growth plate. Growth plates are necessary for normal skeletal development of a child and so, avulsion fractures must be treated with utmost care. Surgery is the only option, to align the growth plate and stabilize it. If there is no danger of lasting growth problems and if the avulsion fracture is well aligned, then surgery is not necessary.

Normally, avulsion fractures can be treated without surgery since it is treated as a soft-tissue injury. An avulsion fracture of the hamstring attachment on the pelvis can be treated in the same way as a hamstring tear. Surgery is considered only when the bone is pulled too far from its original position. Some ankle sprains where the damaged ankle ligaments pull off a tiny piece of a bone from the joint are treated like an ankle sprain. Avulsion fractures in children are more complicated.

Avulsion fracture of the pelvis

Teenagers and sports persons are susceptible to a type of pelvic fracture. Often some of the pulled muscles may end in an avulsion fracture not detected earlier. The muscle in the pelvic area tears away a small piece of bone from the top of the hip bone and there may be sudden muscle contractions. The entire pelvic ring is not involved and there is no injury to the internal organs. Avulsion fractures experienced by athletes are stable fractures and will heal without surgery. Elderly persons with osteoporosis are also at a risk for pelvic fracture. It can occur during a fall or when descending stairs. Normally the pelvic ring is not damaged but any of the individual bones of this ring may be fractured. Mostly these pelvic fractures involve high-energy forces. Motor vehicle accident, crush accident and fall are the major causes for this type of fracture. Pelvic fractures can be life-threatening depending on the amount of force involved.

Acute pain, swelling and bruises are symptoms of pelvic injuries. To avoid aggravating the pain, a patient may walk with a bent knee. There may be injuries to other parts of the body like head, legs or the chest, if the injury is due to trauma. Heavy bleeding can lead to shock should be arrested immediately. The doctor will request for X-rays from different angles to find out the exact degree of displacement to the bones. A CT scan will reveal the extent of other injuries. It is routine to examine the blood vessels and nerves to the legs for any damage due to the injuries.

Sciatica

Sciatica is described as pain, numbness or tingling in the leg due to compression of the sciatic nerve. The sciatic nerve runs down the back of each leg from the lower spine. The pain associated with sciatica can range from dull ache to excruciating pain that makes movement difficult. The pain may be felt in the buttock, down the back of the leg, below the knee and in the foot.

Causes of sciatica

• Disc herniation
  
• Pelvic fracture
  
• Spinal tumors
  
• Pelvic injury
  
• Pain along one side of the body
  
• Worsening in cold weather
  
• Osteoarthritis causing pressure on the sciatic nerve
  

A physical examination along with checking of reflexes on bending, lifting the leg etc are done. X-ray and MRI might be done. Typically sciatica is indicative of another medical problem; which must be attended to. NSAIDs and ice packs provide relief from the pain. Lifting of heavy objects and strenuous back bending are to be avoided. Physical therapy, massage therapy and stretching exercises might help in tackling chronic sciatica.