Pelvic fractures

Fractures of the pelvic ring are significant injuries that affect diverse population groups. They range from low-energy, stable fractures to high-energy, unstable injuries with a substantial morbidity and mortality. The osseous and ligamentous relationships involved in maintaining the stability of the pelvis are complex, and knowledge of these is essential to appropriately manage pelvic fractures. The mechanism of injury and force vectors involved may be used to predict pelvic instability, likely additional injuries, and management strategies. Initially, temporary stabilization, blood-based resuscitation, and appropriate imaging are required. Further haemorrhage control, via embolization, may be required. Urogenital injuries should be identified and treated early. Definitive pelvic fixation should take place once haemodynamic compromise has been reversed and normal parameters maintained, and should aim to restore anatomic alignment and pelvic stability. In addition to the acute risk of major haemorrhage and death, pelvic fractures are associated with long-term morbidity due to gait disturbances, chronic pain, non-union, mal-union, and neurological and urogenital disruption. Therefore, the management of pelvic fractures provides a challenge for clinicians from their initial presentation through to their definitive treatment.