Pelvis Fracture
What is it: A fracture of the pelvic ring or acetabulum. Stable pelvic fractures generally involve only one side of the pelvic ring. Unstable pelvis fractures disrupt the pelvic ring at more than one site.
How does it present: Most elderly patients will present with groin or buttock pain after a fall and difficulty with weight bearing. If the pelvic injury was related to signifiant trauma, always look for other associated injuries, especially genitourinary injuries.
Common exam findings: Inspect the pelvis for deformity, swelling and open injuries. A thorough musculoskeletal examination may avoid overlooking other associated injuries. A neurovascular exam should be documented. Patients may report a painful range of motion at the hip, inability to perform a straight-leg lift, and groin or buttock pain with attempts at bearing weight and may be tender to palpate regions of the pelvis and hip.
Tests and treatment: AP radiographs of the pelvis should identify most pelvic fractures. If a pelvic fracture is identified, inlet and outlet views help to identify the injury pattern. Acetabular fractures require oblique views of the pelvis to fully define the extent to the fracture. CT scans are often needed for complex injuries and to plan surgical intervention. Treatment of stable pelvic fractures includes rest and progressive weight bearing as tolerated. Unstable pelvic fractures require surgical consultation for management.