Pelvic Fracture (Broken Pelvis)

What to do after a serious pelvic injury

1. Call 911 or your local emergency number.
2. Do not move the person unless they are in danger. Movement can worsen bleeding.
3. Keep them lying flat, warm and still.
4. Do not give food or drink.
5. Paramedics may apply a pelvic binder, a wide strap around the hips, to hold the pelvis together and reduce bleeding.

The pelvis

The pelvis is a ring formed by the two hip bones (each made of the ilium, ischium and pubis) joined at the front by the pubic symphysis and at the back to the sacrum by the sacroiliac joints. It protects the bladder, bowel, reproductive organs and large blood vessels and nerves. Because it is a ring, a break in one place is often accompanied by a break or joint injury in another.

Types of pelvic fracture

Pelvic fracture vs hip fracture

A hip fracture is a break in the top of the thighbone (femur), just below the hip joint. A pelvic fracture is a break in the pelvic bones themselves. Both are common after falls in older adults and cause groin pain, but hip fractures usually need surgery, while most low-energy pelvic fractures do not. X-rays tell them apart.

Symptoms

• pain in the groin, hip, buttock or lower back, worse with moving the legs or walking
• difficulty or inability to walk or stand
• bruising and swelling over the hips, groin or perineum
• numbness or tingling in the groin or legs
• blood in the urine or difficulty urinating
• signs of shock in severe injuries: dizziness, fast pulse, pale cold skin

Complications of high-energy fractures

• Severe bleeding from pelvic veins, arteries and bone, which can be life-threatening. See internal bleeding.
• Bladder and urethra injuries, especially in men. See bladder injury.
• Bowel and vaginal injuries in open fractures.
• Nerve damage to the sacral nerves, affecting leg strength, bladder, bowel and sexual function.
• Blood clots in the legs and lungs during recovery.
• Chronic pain, limp and leg length difference.

Diagnosis

• Examination: gentle assessment of pelvic stability, pulses, nerves, and the perineum, rectum and genitals.
• X-ray of the pelvis.
• CT scan: shows the fracture pattern and bleeding in detail.
• FAST ultrasound in trauma to look for internal bleeding.
• Urine tests and bladder imaging if a urinary injury is suspected.
• MRI for suspected insufficiency fractures in older adults when X-rays look normal.

Treatment

Stable, low-energy fractures

• Pain relief: acetaminophen (paracetamol) first, with stronger options as needed.
• Early walking with a walker or crutches, bearing weight as pain allows; prolonged bed rest causes clots, pneumonia and muscle loss.
• Physical therapy.
• Blood clot prevention when mobility is reduced.
• Osteoporosis assessment and treatment to prevent further fractures.
• Some older adults need a short hospital stay or rehabilitation facility.

Unstable, high-energy fractures

• Resuscitation: blood transfusion and a pelvic binder.
• Stopping bleeding: angiographic embolization, pelvic packing or external fixation.
• Surgery: plates and screws or external fixators to restore and stabilize the pelvic ring.
• Repair of bladder, urethra or bowel injuries.
• Rehabilitation: often weeks to months of protected weight-bearing and therapy.

Recovery time

• Stable pubic ramus fractures: pain improves over 2 to 6 weeks; bones heal in about 6 to 12 weeks.
• Unstable fractures after surgery: bone healing takes about 3 months, with full recovery often taking 6 to 12 months or longer.
• Older adults may need extra support to regain independence.

Prevention

• Reduce fall risk with strength and balance exercise, home safety and a review of medicines.
• Treat osteoporosis.
• Wear seat belts and motorcycle protective gear.

Frequently asked questions

What are the symptoms of a broken pelvis?

Symptoms include pain in the groin, hip, buttock or lower back that worsens with walking or moving the legs, difficulty standing, bruising and swelling around the hips or groin, and sometimes numbness or blood in the urine. Severe injuries can cause signs of shock.

How long does a pelvic fracture take to heal?

Stable pelvic fractures in older adults usually heal in 6 to 12 weeks, with pain improving after a few weeks. Unstable fractures needing surgery take about 3 months for the bone to heal and often 6 to 12 months for full recovery.

Can you walk with a fractured pelvis?

With a stable fracture, such as a pubic ramus fracture, walking with a walker or crutches is usually encouraged as soon as pain allows, because it speeds recovery. With an unstable fracture, weight-bearing is restricted until the bones are stabilized and healing.

Does a pelvic fracture need surgery?

Most low-energy, stable pelvic fractures do not need surgery and heal with pain relief and early movement. Unstable fractures from high-energy trauma usually need surgery to stabilize the pelvis and control bleeding.

Is a pelvic fracture serious in the elderly?

It can be. Even a stable fracture can cause significant pain, reduced mobility, loss of independence and complications such as blood clots and pneumonia. Early walking, good pain control, rehabilitation and osteoporosis treatment improve outcomes.