Fractures of the pelvis can be classified as isolated fractures or fractures with disruption of the pelvic ring. Isolated fractures involve single bones like the pubis or ischium and are typically treated with pain relief, bed rest, and leg exercises. Fractures with pelvic ring disruption require urgent care for shock and involve two fractures on opposite sides of the pelvis, often stabilized with internal or external fixation to reduce displacement. Complications can include injuries to internal organs like the bladder or urethra, which may require surgical repair.

1. 1
FRACTURES OF THE PELVIS

2. Classification
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 1. Isolated fractures and undisplaced fractures of
the ischium and pubis that do not seriously disrupt
the integrity of the pelvic ring
 2. Fractures with disruption of the pelvic ring.
 Caused by direct injury or by violence transmitted
longitudinally through the femur.

3. ISOLATED FRACTURES
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 May affect any part of the pelvis
 Fracture of superior pubic ramus
 Fracture of inferior ischio-pubic ramus
 Fracture entering the acetabulum
 Fracture of the wing of ilium
 Avulsion fracture of the anterior inferior iliac spine
(violent contraction of rectus femoris muscle)

4. Treatment
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 Relief of pain
 Rest in bed for 1-3 weeks
 Exercises for the lower limbs from the beginning

5. Complications
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 Uncommon
1. Injury to the urethra
2. Injury to the urinary bladder
3. Osteoarthritis of the hip due to injury of articular
surface of acetabulum

6. FRACTURES WITH DISRUPTION OF THE
PELVIC RING
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 Disruption of the pelvic ring can occur only if
there are fractures or dislocations at two points
approximately opposite one another.
 A fracture in the anterior half of the ring with
separation of the fragments must be associated
with an injury in the posterior half of the ring.

7. Cont…
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 Mostly, the anterior injury is a fracture through
both ischio-pubic rami with separation, or a
disruption of the symphysis pubis.
 The posterior injury is usually a subluxation of
the sacro-iliac joint, or a fracture through the
ilium or the ala of the sacrum near the sacro-
iliac joint.

8. Mechanism of the injury
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 1. Anterior-posterior crushing (open book injury)
 2. Compression from side to side (closed book
injury)
 3. A vertical shearing force, which may cause
marked displacement of one half of the pelvis.

9. Treatment
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 Manage severe shock due to internal haemorrhage
 I.V. line
 Blood for grouping and cross-match
 I.V. fluids (plasma expanders, normal saline)
Manage the fracture itself

10. Slight displacement
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 Rest in bed until the two halves of the pelvis become
united reasonably firmly (4-6 weeks)
 Exercises for the lower limbs daily to keep the joints
mobile and the muscles active

11. Disruption of the symphysis pubis
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 Reduce the displacement fully and stabilize
the position without delay
 Manual pressure with patient recumbent in lateral
posture, and a plaster spica applied
 Hammock traction
 External fixation – two or three threaded pins
inserted into the anterior part of the wing of ilium
on each side, and after reduction, the pins are
clamped to a metal bar or frame placed transversely
over the front of the pelvis
 Internal fixation by contoured plate and screws

12. Upward displacement of the half pelvis
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 Attempt reduction by heavy weight traction through
a femoral or tibial pin.
 May opt for open reduction and internal fixation

13. Complications
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 Rupture of bladder
 Rupture of the urethra
 Injury to the rectum or vagina
 Injury to a major blood vessel
 Injury to nerves
 Involvement of the acetabulum with subsequent
osteoarthritis.

14. RUPTURE OF BLADDER
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 Bladder may be torn open in disruptions of the
symphysis pubis
 May be penetrated by spike of bone
 The rupture is usually extra-peritoneal, and urine is
extravasated into the perivesical space.
 The patient is shocked.
 Complains of desire to pass urine but is unable to do
so.
 Catheter passes easily into bladder but only a few
drops of blood-stained fluid escape.

15. Treatment of ruptured bladder
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 Urgent operation is required by urological surgeon.
 The principles of treatment are: -
 To suture the rent
 To drain the bladder
 To drain the perivesical space

16. Rupture of the urethra
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 Most common in cases of wide disruption of
the symphysis pubis
 Rupture is usually in the membranous part
 Extravasation occurs into the perineum if
patient tries to pass urine.
 Patient should be warned not to attempt to
pass urine.
 It is impossible to pass a catheter into the
bladder
 There may be a little blood at the meatus.

17. Treatment of ruptured urethra
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 Urgent operation is required
 The principles of treatment are to:
 Identify the torn ends of the urethra through incisions in the
perineum or bladder
 Suture the ends, if necessary over a rubber catheter passed into
the bladder
 Drain the bladder suprapubically
 Close the perineal wound with drainage.

18. T H A N K S
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The end.