Pelvic fractures (summary)

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This is a basic article for medical students and other non-radiologists

Pelvic fractures are a heterogeneous group of injuries that can occur secondary to a variety of mechanisms that range from an innocuous simple fall to severe high-energy trauma in a road traffic collision.

Reference article

This is a summary article. For more information, you can read a more in-depth reference article: pelvic fractures.

Summary

  • anatomy
  • epidemiology
    • all age-groups with bimodal age and sex distribution
  • presentation
    • older patients may present after a simple fall
    • younger patients more likely to have a higher energy mechanism
    • polytrauma patients may be cardiovascularly unstable
      • associated pelvic bleeding
  • pathology
    • type of fracture is dependent on mechanism, energy and bone-strength
      • direct impact, low energy (solitary localized fractures)
      • compression, high energy (unstable pelvic ring fractures)
    • mechanism is almost always blunt trauma, e.g. fall or RTC
    • certain fractures are associated with vascular injury which can lead to massive hemorrhage, shock and death
  • radiology
    • plain pelvic radiograph useful in all settings
    • CT helpful for assessment of complex fractures
      • especially those involving the sacrum and joints such as the hip and sacroiliac joints
      • CT angiography is required to assess for vascular injuries and other associated injuries such as bladder rupture
  • treatment
    • dependent on the type of fracture
      • ranges from non-operative to internal fixation and even joint replacement
    • complex or unstable ring fractures may require external fixation prior to definative internal fixation

Radiographic features

The radiographic features are varied and even for serious and severe injuries can be subtle on plain radiographs.

  • stable injuries
    • pubic ramus fracture
    • acetabular fracture
      • with hip dislocation
    • iliac blade fracture
    • sacral alar fracture
  • pelvic ring fractures
    • anteroposterior compression injury
    • lateral compression injury
    • vertical shear injury
X-ray

X-ray is a quick and simple test that will detect the majority of pelvic fractures. They can be difficult to assess because of the complexity of the shape of the sacrum, pelvis and proximal femora.

CT

CT is the modality of choice for accurately depicting complex acetabular or pelvic ring fractures. After an initial plain radiograph, a CT is often required to make an accurate assessment of the fracture.

In polytrauma, CT chest, abdomen and pelvis with contrast is often performed and accurately depicts pelvic fractures along with associated organ and vascular injury. A plain film is often still helpful in the immediate trauma management even if a CT is planned.​

Medical student radiology curriculum