Pelvic Ring Fractures and Auto Accidents

Pelvic ring fractures are unfortunately one of the main causes of mortality and morbidity when it comes to automobile accidents. This is partly because these fractures are very vascular and internal bleeding is common. They also can puncture the urinary bladder and the colon, leading to infection and the need for internal surgery.

These patients also have a high degree of other injuries along with their pelvic ring fracture so that doctors must repair many body areas along with the pelvic ring fracture. Other injuries can include internal injuries, leg fractures, rib fractures and head injuries.

Fractures of the pelvis can be stable or unstable and it’s the unstable ones that lead to the biggest morbidity and mortality. Fractures of just one or two pubic rami are generally stable with minimal bleeding. Fractures of the ring of the pelvis, including the connection between the sacrum and the pelvic bone itself are extremely unstable with no ability to walk unless the fracture is connected through screws and plates in surgery. Just one joint can be affected or both sacroiliac joints can be fractured and often dislocated.

In one study, researchers decided to determine which vehicular factors, what crash characteristics and what occupant characteristics contributed to the development of pelvic ring fractures. A total of 240 adults were studied who were in front end or side end collisions. The crashes were reconstructed in detail and were prospectively studied. Detailed information on the nature of the crash, the type of victim and the type of vehicle were studied.
Of the total of 240 study participants, 38 sustained a pelvic ring fracture. Most of the victims were females who were in side impact crashes. There was usually a great deal of vehicle incompatibility with the victims in the smaller vehicle. The crashes tended to be more severe and it appeared that there was no protection from seat belts or air bags. This was true even in front end crashes. The vehicles were all new at the time of the crash or at least less than 6 years old. This means that they all had the latest in design features to protect victims from crash-related injuries.

There appears to be an increase in pelvic ring fractures in crashes involving older vehicles with fewer protective design features. The increase has been modest and there appears to be further improvements necessary in design features. Lateral impacts were more associated with pelvic ring fractures so that these are the areas of increased design fractures needed. Things such as side impact air bags are necessary to reduce the incidence of pelvic ring fractures, especially in women.

The prognosis of pelvic ring fractures is guarded. The person who survives this type of injury almost always needs surgery to hold the pelvic ring together. Ambulation is possible with physical therapy but the patient may forever need some kind of assistive device in order to ambulate quickly and safely. The hardware used to hold the pieces together almost always stay in the patient for the duration of their life.

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