Pelvic Fractures: Everything You Need To Know

You are cheering for your grandson at his little league baseball game. He’s up to bat and BOOM! He hits one deep into left field! You jump up to cheer but slip and land hard on your butt! You experience sharp pain in your groin and you can’t sit or stand without excruciating pain. You are able to move your hips and put some weight on your legs, so you think you are in the clear… but what else could be causing your pain? Unfortunately, you AREN’T in the clear because you broke your pelvis! Let’s take a closer look at pelvis fractures and why we want to prevent them!

A broken pelvis refers to a fracture in any of the sturdy ring of bones that make up the pelvis, which connects your back to your legs. These bones include the sacrum and coccyx (tailbone) on your backside, as well as the pelvic girdle which is divided into the ilium, ischium, and pubis bones. Those with osteoporosis are most likely to injure the parts of the pelvis known as the pubic rami, as well as the sacrum.

If you have normal bones, pelvic fractures are caused by high energy injuries including car accidents or a fall from a significant height. However, if you have osteoporosis you may break their pelvis following minor trauma, such as a fall from a standing height onto the side of your hip or buttocks. The impact of the fall is transferred to the pelvis, and usually leads to 2 or more breaks in the bone. Picture the pelvis as a hard pretzel. If you twist a pretzel, it is nearly impossible for the pretzel to break in only one spot. If enough force is applied to cause a break, the pretzel will break in at least 2 spots.

Just how common are these fractures?
The true number is difficult to know since most of our current research is focused on the management of life-threatening pelvic fractures following high-energy trauma. It is estimated that osteoporosis leads to more than 140,000 pelvis fractures each year in the United States, with a price tag in the hundreds of millions of dollars.

What are symptoms of pelvic fractures?
Immediately following a broken pelvis, it is common to experience pain, swelling and bruising. Pain can be excruciating and leads to difficulty with walking or the complete inability to place any weight on your legs. Hip motion leads to pain in the groin, hip, or lower back depending on the location of the fracture. Rarely, severe pelvic fractures can lead to injuries to nerves and blood vessels, which can impact bowel and bladder function.

How are pelvic fractures treated?
Fortunately, the majority of osteoporosis-related pelvic fractures can be managed without surgery. The focus of treatment is on pain management and regaining strength, motion, and mobility with physical therapy. Most people will require a hospital/nursing home stay lasting anywhere from a few days to a few months depending on the severity of the pain and level of disability following the injury. Pain often subsides over the first 6 weeks, and most people report minimal pain within 3 months. Severe fractures that lead to instability of the pelvis are typically the result of high-energy trauma and can be life threatening injuries. These require emergency medical management and surgery.

What are complications of pelvic fractures?
Stable osteoporosis-related pelvic fractures that do not require surgery often heal well without long term complications. When complications occur, they are usually related to inactivity and include blood clots and muscle weakness. One study reported that 1 year following these fractures, 84% of people reported minimal or no pain. Over 90% of people will return to doing all of the activities they enjoyed prior to their injury. Poor recovery with long term functional limitations are more likely to occur in older adults, particularly in those with dementia.

The bottom line on pelvic fractures…
Pelvic fractures are relatively common and occur following a fall onto the side of the hip or buttocks. The majority of osteoporosis-related pelvis fractures can be managed without surgery, and long term pain and loss of function is seen in less than 10% of people. Severe pelvic fractures may be a medical emergency requiring urgent medical attention and surgery. Poor healing and long term disability is more likely to occur in those with advanced age and dementia.