Overview
The pelvis is a ring of bone. It is made up of the sacrum (the triangular bone at the base of the spine) and the two large hip bones. Because it is a ring, an injury on one side is almost always paired with an injury on the other. A ring rarely breaks in only one place. High-energy pelvic ring fractures can be life-threatening. Large blood vessels run through the pelvis and can bleed heavily, and nearby organs can be injured.
The first priority is to control bleeding and steady your blood pressure. This often starts with a pelvic binder, a wrap that compresses the pelvis. In select cases, a frame outside the body (an external fixator) holds the ring steady through pins in the bone. It can be placed in the emergency department. The permanent internal repair is done once you are stable. The technique is chosen to match your fracture pattern.
Why it's done
We typically consider this surgery when imaging and the exam together show the fracture will not reliably heal or work without fixation. Common reasons include:
An unstable ring
A ring that can shift up and down or twist out of position cannot be trusted to heal in place. It needs internal fixation.
A shifted break at the back of the ring
Screws passed through the skin into the sacrum restore stability to the back of the ring.
A separated joint at the front of the pelvis
When the joint at the front of the pelvis has pulled apart, a plate across it restores the front of the ring.
A nearby break of the hip socket
When the ring injury comes with a fracture of the hip socket, the repair is done in planned stages.
Bleeding that is hard to control
If bleeding has not been controlled, an external fixator or a binder may be lifesaving.
How it works
Injuries to the back of the ring are often fixed with long screws (iliosacral screws) passed through small skin punctures and guided by live X-ray. Nerves and blood vessels run close to the screw path. Placing these screws safely takes a detailed knowledge of pelvic anatomy.
Injuries to the front of the ring, such as a pubic symphysis (the joint at the front) that has pulled apart, are fixed with a plate. The incision is the same low, horizontal one used for a C-section. An external frame at the front may also be used, short-term or permanently, depending on your fracture pattern and overall condition.
Recovery
Weight-bearing after pelvic fixation is protected during early recovery. Your team will tell you exactly how much weight you can put through your legs. Moving in bed, transfers, and walking with help begin as soon as you can manage it. Bladder, bowel, and sexual function are watched closely, because these injuries can affect the nerves that run through the pelvis. Non-union (the fracture failing to heal) and malunion (healing in a poor position) are known risks, above all with badly shattered or displaced fractures. Any external frame is removed once the back of the pelvis has healed.
Contact
For questions about this procedure or to schedule an evaluation, call the office at (830) 625-0009 or schedule an appointment online.
Physicians Who Perform Pelvic Fracture Fixation
Weight-Bearing After Repair
Controlled load is part of how bone heals. Once the fracture is stabilized with hardware, gentle weight through the limb helps build callus (the new bone that bridges a fracture). Keeping all load off a fixed fracture for too long can actually slow healing and stiffen the joints above and below. Full body weight right away, however, can overload the repair before bone has caught up. The right answer sits in between. Your surgeon sets a step-by-step loading plan. It is based on your fracture pattern, the strength of the fixation, your bone quality, and how the repair looks on X-rays after surgery. We tell you exactly how much weight the limb can take, when to advance, and what to watch for.
Frequently Asked
questions we hear in clinicWhy is a pelvic ring fracture treated as an emergency?
High-energy pelvic ring fractures can be life-threatening. Large blood vessels run through the pelvis and can bleed heavily, and nearby organs can be injured. The first priority is to control bleeding and steady your blood pressure; the permanent repair is done once you are stable.
Why does my pelvis have breaks in more than one place?
The pelvis is a ring of bone, and a ring rarely breaks in only one place. An injury on one side is almost always paired with an injury on the other.
Why did I have a binder or an external frame before surgery?
Bleeding control often starts with a pelvic binder, a wrap that compresses the pelvis. In select cases, a frame outside the body holds the ring steady through pins in the bone and can be placed in the emergency department. Any external frame is removed once the back of the pelvis has healed.
How is the fracture actually fixed?
Injuries to the back of the ring are often fixed with long screws passed through small skin punctures and guided by live X-ray. Injuries to the front, such as a pubic symphysis that has pulled apart, are fixed with a plate through the same low, horizontal incision used for a C-section.
When can I put weight on my legs?
Weight-bearing is protected during early recovery, and your team will tell you exactly how much weight you can put through your legs. Moving in bed, transfers, and walking with help begin as soon as you can manage it, because controlled load is part of how bone heals.
Can this injury affect bladder or bowel function?
Bladder, bowel, and sexual function are watched closely after these injuries, because the nerves that control them run through the pelvis.
Further Reading
External patient-education references and related OSI pages for additional background: