Pelvic ring injuries

Abstract

Pelvis is a strong bony-ligamentous structure containing many organs, vessels and nerves. Three forces or a combination of those forces produce pelvic fractures. The main causes of pelvic fractures are traffic accidents and falls from height. Biomechanically pelvic ring can be stable or unstable. Biomechanically unstable pelvic ring after the injury may provoke hemodynamic instability. Mortality rate in hemodynamically unstable patients with pelvic fractures remains high. Hemodynamically unstable patients require urgent closing of the pelvic volume with pelvic C clapms or external fixator. This fixation is usually temporary. The massive venous bleeding from the injured pelvis needs the pelvic packing (tamponade); arterial bleeding needs angiography and embolization. After a patient´s hemodynamic status stabilizes, further evaluation and mechanical stabilization of the pelvis is needed. The definitive stabilization of the pelvis includes hemodynamically stable patients and implies anterior, posterior or both anterior and posterior pelvic ring fixation. The main indication for the anterior stabilization is symphyseal diastasis greater than 2,5 cm. Anterior stabilization can be achieved with external fixator or with symphyseal plating. The primary indication for surgery of posterior pelvic ring complex is vertical pelvic instability. Stable mechanical fixation can be applied with anterior sacro-iliac plating, percutaneous ilio-sacral screws, and trans-iliac sacral bars. Inadequate treatment of pelvic injury may cause permanent disability and serious chronic disorders.