The pelvis is made up of pairs of large broad (iliac) bones in the back joined by two smaller connecting bone struts (the pubic and ischial rami) in the front. In young adults, major fractures of the entire pelvis can occur as a result of high-speed motor vehicle accidents or falls from a height. These fractures can cause life-threatening bleeding and injury to internal organs. In older people, the rami, often weakened by osteoporosis, can fracture from even a minor fall on level ground.
With fractures of the pelvic rami, most people feel considerable pain in the groin, even when lying down or sitting. The pain becomes much worse when people try to walk, although some are able.
People with major pelvic fractures have severe pain and are unable to walk.
Doctors suspect a pelvic fracture based on the symptoms and confirm the diagnosis using x-rays. Sometimes, computed tomography (CT) or magnetic resonance imaging (MRI) is required.
Prognosis and Treatment
People usually need to be admitted to a hospital or rehabilitation center.
Stable fractures of the pelvic rami typically heal without causing permanent disabilities and rarely require surgical treatment. Analgesics and nonsteroidal anti-inflammatory drugs (NSAIDs—see Pain: Nonsteroidal Anti-Inflammatory Drugs) help relieve pain and inflammation. To avoid the weakness, stiffness, and other complications that occur with bed rest, walking and bearing weight fully should begin as soon as possible. People with fractures of the rami can try to walk without causing further injury to the area. Most people can walk short distances with a walker by 1 week and are moderately comfortable in 1 to 2 months.
Major pelvic fractures are often unstable and require immobilization. Doctors sometimes attach a rigid metal frame to the pelvis using screws driven into the bone. Permanent disability often results if the socket of the hip joint has been damaged. Because of the large amount of force required to cause a major pelvic fracture, internal organs are also often damaged. The mortality rate for this type of injury is high.
Last full review/revision December 2008 by James R. Roberts, MD