Displaced fractures of the pelvic ring constitute a diverse group of skeletal injuries that usually result from motor-vehicle accidents, industrial trauma, sporting events, or falls from great heights.
The typical pelvic ring disruption is notable for the immense amount of force needed to provoke a displacement of the pelvic ring.
A patient who sustains such an injury is likely to present with other serious or life-threatening injuries involving the musculoskeletal, respiratory, central nervous, gastrointestinal, urologic, and cardiovascular systems.
The management of a pelvic ring fracture, requires concomitant diagnosis and treatment of the other systemic and musculoskeletal injuries.
Historically, the management of the patient with a pelvic ring fracture has focused on the emergency care of the associated injuries with an initial neglect of the osseous disruption. Uusally, the immobilization of the pelvic fracture was accomplished by bed rest and possibly the application of a pelvic sling, skeletal traction, or a hip spica cast.
Such marginally effective methods of stabilization are madequate for the control of profuse retroperitoneal hemorrhage, which often complicates acute pelvic disruption. Furthermore, bed rest and especially the use of a pelvic sling were notable for extraordinary discomfort and general failure to achieve an accurate reduction of a displaced fracture dislocation.
All of these methods were associated with nearly complete immobilization of the patient, with the concomitant complications of prolonged, enforced recumbency including urinary retention, urinary tract infections, pulmonary emboli, infections, decubitus ulcers, and sloughing of soft tissues under a sling.
In the past, most traumatologists tried to minimize complication by reacting to problems that arose during or after a period of enforced recumbency rather than anticipating the need for surgical intervention. Historically, this reactionary former has characterized the whole management protocol for pelvic trauma, including investigative procedures.
There is widespread and incorrect notion among traumatologists that most pelvic fracture victims who survive these injuries have few major late problems. Notable late problems are including pelvic pain, abnormalities of gait, limb-length discrepancy, permanent nerve damage, and genitourinary tract problems.
About 40% of the patients complain of late pelvic pain with or without a persistent deformity or a mobile nonunion.
Early open reduction and internal fixation appears to reduce the incidence of these late problems. Potential complications of the surgery are likely to occur unless the surgical team is appropriately trained.
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