Fractures of the Pelvis

The pelvis is made up of pairs of large broad (iliac) bones in the back joined by two smaller connecting bone struts (the pubic and ischial rami) in the front. In young adults, major fractures of the entire pelvis can occur as a result of high-speed motor vehicle accidents or falls from a height. These fractures can cause life-threatening bleeding and injury to internal organs. In older people, the rami, often weakened by osteoporosis, can fracture from even a minor fall on level ground.

Symptoms and Diagnosis

With fractures of the pelvic rami in older people, most people feel considerable pain in the groin even when lying down or sitting; this pain becomes much worse when the person tries to walk. The person may need to be admitted to a hospital or rehabilitation center.

Doctors suspect a pelvic fracture based on the symptoms and confirm the diagnosis using x-rays. Sometimes, computed tomography (CT) or magnetic resonance imaging (MRI) is required.

Prognosis and Treatment

Fractures of the pelvic rami in older people typically heal without causing permanent disabilities and rarely require surgical treatment. Analgesics and nonsteroidal anti-inflammatory drugs (NSAIDs) (see Section 6, Chapter 78) help relieve pain and inflammation. To avoid the weakness, stiffness, and other complications that occur with bed rest, walking and bearing weight fully should begin as soon as possible. Because the iliac arches rather than the rami are used for structural support while walking, people can try to walk without injuring the area further. Most people can walk short distances with a walker by 1 week and are moderately comfortable in 1 to 2 months.

In young adults, a pelvic fracture due to trauma often requires emergency surgical treatment, and permanent disability often results if the socket of the hip joint has been damaged.