Pelvic Fractures

Pelvic fractures

Pelvic fractures range from low‑energy, stable injuries (e.g., pubic rami, acetabular or avulsion fractures) to high‑energy pelvic ring disruptions that can cause life‑threatening haemorrhage. Unstable pelvic ring injuries require immediate, protocolised resuscitation focused on rapid haemorrhage control, physiological resuscitation and early escalation to definitive therapy (NICE NG39, NG37; Resuscitation Council UK).

Why pelvic fractures matter in resuscitation

• Pelvic ring disruption can cause massive occult bleeding from cancellous bone, the pelvic venous plexus and, in 10-20% of cases, arterial branches (commonly internal iliac branches such as the superior gluteal).
• Mortality is high in unstable and open pelvic fractures; prompt recognition, early haemorrhage control and activation of major haemorrhage pathways save lives.
• High‑energy mechanisms (motor vehicle collisions, pedestrian strikes, falls from height) should raise suspicion for significant pelvic injury.

Relevant anatomy (clinical focus)

• The pelvic ring comprises the paired innominate bones (ilium, ischium, pubis), sacrum and coccyx. Stability depends on the anterior and posterior elements and sacroiliac ligaments.
• Important stabilising ligaments: sacrotuberous, sacrospinous, iliolumbar and anterior/posterior sacroiliac ligaments.
• Diastasis of the symphysis pubis indicates anterior ring disruption (e.g., open‑book / APC injury).
• Vascular considerations: most bleeding is venous (pelvic plexus, bone surfaces); arterial bleeding arises from internal iliac branches.
• Extra‑pelvic vascular injuries (femoral/iliac vessels) and intra‑abdominal sources must be excluded as potential contributors to haemodynamic instability.