The pelvis is an irregularly shaped bone that connects the spine to the lower extremities. Pelvic fractures are usually the result of high energy trauma like car accidents but can result from ground level falls in older individuals with softer bones. There are two main types of pelvic bone fractures: Acetabulum or hip socket fractures and pelvic ring fractures. Both are highly complex injuries that required a trained specialist in to fully evaluate and manage.
We have specialized fellowship training in the surgical management of displaced or unstable pelvic ring and acetabulum fractures and treat approximately 75 surgical cases per year. Many of these patients are transferred in from outside hospitals that do not have a surgeon who performs pelvic fracture surgery.
High Energy Pelvic Ring Fractures
Low Energy Pelvic Ring Fractures
There are several important factors for patients, or more commonly their families, to consider when looking for a surgeon to treat their injury. Important questions to ask the surgeon are: How many of these procedures have you done? How many do you do per year? Do you have specialized (fellowship) training in pelvic fracture surgery? Most of these injuries are difficult to treat well and surgery should be performed by a surgeon with experience in treating these injuries.
Another important consideration is the ability of the institution to take care of the multiply injured patient. Most pelvic fractures do not occur in isolation but are one of several injuries incurred by the patient. These injuries often require a team of physicians, nurses, therapists and social workers who help manage all aspect of care.
We practice at regional trauma centers with dedicated trauma ICU and trauma teams caring for a high volume of multiply injured patients. In addition, we use specialized operating room equipment and tables that are a necessity in treating these injuries properly. Although many community hospitals have nicer rooms and more comfortable and accessible settings, they are often ill-equipped to care for multiply injured patients. This leads to sub-optimal clinical outcomes and higher complication rates.
Another factor is timeliness of transfer. In most cases the first day or so in spent on resuscitation, where life threatening issues are addressed and fluids and blood are replenished in an ICU setting.
The window of opportunity to surgically manage these injuries is within the first 3-4 days after injury. After this, a systemic inflammatory condition ensues which generally makes repair risky for the next 4-6 days. The best outcomes are obtained if the transfer can occur quickly and definitive care is performed early. Delaying definitive treatment beyond 14 days leads to markedly worse outcomes. We can have most patients transferred within 24 hours and often within 8 hours if their condition has been stabilized. This allows us to definitively repair most fractures before the 3-4 day window closes.