Pelvic fracture

Classification according to ICD-10
S32.-	Fracture of the lumbar spine and pelvis
S32.1	Fracture of the sacrum
S32.2	Fracture of the coccyx
S32.3	Fracture of the ilium
S32.4	Fracture of the acetabulum
S32.5	Fracture of the pubis
S32.7	Multiple fractures involving the lumbar spine and pelvis
S32.8	Fracture of other and unspecified parts of the lumbar spine and pelvis
ICD-10 online (WHO version 2019)

A pelvic fracture is a broken bone in parts of the bony pelvis . It usually occurs as a result of traffic accidents or falls. The hip joint is often involved ( acetabular fracture ). Internal bleeding in pelvic fractures is life-threatening.

Classifications

Tile classification

One differentiates (after Pennal and Tile):

• Stable pelvic injury (type A): In the case of fractures or tears in the marginal areas (upper iliac blades, ischium , pubic bone , muscle origins), on the coccyx below the sacroiliac joint or on the anterior pelvic ring with preserved ligaments without significant displacement
• Rotationally unstable pelvic ring injury (type B): In the case of a displaced fracture of the anterior pelvic ring or a ruptured symphysis, but stability of the posterior structures (even if involved). Type B pelvic fractures are often clearly referred to as open book fractures, because the pelvic blades can be opened outwards when the symphysis or anterior pelvic ring is destroyed .
• Rotational and vertically unstable pelvic ring injury (type C): If the sacrum or sacroiliac joint is broken and the anterior pelvic ring is fractured or the symphysis is ruptured (Malgaigne fracture, named after the surgeon Joseph-François Malgaigne, 1806–1865). Occurrence: Often with compression along the body axis

Young-Burgess classification

With this classification, the stability, the fracture pattern and the direction of the force of the injury can be assessed.

• Anterioposterior compression fractures (APC): Pressure from the front causes the pelvis to unfold . Depending on the impact of the trauma, the injury ranges from a tear in the pubic symphysis ( APC 1 ) to a complete tear open of the pubic symphysis and the sacroiliac joint ( APC 3 ).
• Lateral compression fractures (LC): Pressure from the side causes the pubic bone to rupture , often part of the pelvic vane also breaks , either on the same side ( LC 2 ) or contralateral, on the opposite side ( LC 3 ).
• Vertical shear fracture: By pressure from below, e.g. B. when landing on one leg, the two halves of the pelvis are moved vertically against each other. This causes the pubic symphysis and the sacroiliac joint to tear .

Unstable pelvic injuries are often associated with injuries to blood vessels, nerves and internal organs ( urinary bladder , rectum , birth canal ).

Diagnosis

Untreated pelvic fracture; before surgery for a femoral neck fracture

During the inspection and scanning, local swellings and discolorations, misalignments, blockages in the hip joint, pulses and nerve function must be observed. Ultrasound is used to further rule out life-threatening internal bleeding . To assess the bone structure, x-ray overview images are taken with a beam path from the front, possibly additional oblique images from 40 degrees above (in the caudal direction = pelvis inlet ) or from 40 to 60 degrees below (in the cranial direction = pelvic outlet ). Often a CT or an MRI is done directly . The internal organs of the urinary bladder, vagina and rectum are also examined manually, by CT or MRI image or, if necessary, endoscopically (less often).

therapy

Treated pelvic fracture

Stable pelvic fractures are treated conservatively . The earliest possible mobilization is to be aimed for with physiotherapeutic supervision.

Unstable pelvic fractures usually have to be stabilized as an emergency with a pelvic clamp or an external fixator in order to stop internal bleeding through the compression. Bleeding forbids opening the pelvis. Later, the fractures are surgically fixed with plates or screws. Mobilization is possible after about two months.

literature

• Andreas Hirner, Kuno Weise: Surgery cut by cut . Thieme Verlag, Stuttgart 2004, pp. 346-349, ISBN 3-13-130841-9 (+ 1 CD-ROM).

Individual evidence

1. ↑ Barbara I. Tshisuaka: Malgaigne, Joseph-François. In: Werner E. Gerabek et al. (Ed.): Enzyklopädie Medizingeschichte. De Gruyter, Berlin / New York 2005, ISBN 3-11-015714-4 , p. 887.
2. ↑ Clifford R. Wheeless, III, MD: Wheeless' Textbook of Orthopedics , http://www.wheelessonline.com/ortho/young_burgess_system

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !