PELVIC FRACTURES, EPIDEMIOLOGY, ANATOMY, MECHANISM OF INJURY, CLASSIFICATION, IMAGING PRESENTATION, CLINICAL PRESENTATION, MANAGEMENT AND COMPLICATIONS

Abstract

Introduction: Open fractures of the pelvis represent one of the most fatal injuries within musculoskeletal trauma so they must be treated correctly, adjusting to a multidisciplinary approach to achieve the well-being of the affected person, in addition to restoring homeostasis and normal pathophysiology related to the mechanical stability of the pelvic ring.

Objective: to detail current information related to pelvic fractures, epidemiology, anatomy, mechanism of injury, classification, imaging presentation, clinical presentation, management and complications.

Methodology: a total of 27 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 20 bibliographies were used because the other articles were not relevant for this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: fracturas de pelvis, fraturas do anel pelvico, anatomy of the pelvis, fractures of the pelvis.

Results: Most cases of pelvic fractures occur in young people due to high-energy mechanisms, although injuries can also be generated by low-energy mechanisms and can cause fractures of individual bones. Mortality is higher in individuals with hemodynamic instability. The standard imaging examinations in trauma are anteroposterior projections of the thorax, lateral cervical spine and anteroposterior projections of the pelvis; special projections of the pelvis include the oblique alar and obturator projections. The severity of pelvic fractures is closely related to the associated injuries.

Conclusions:  Knowledge of anatomy is a fundamental piece in the treatment of pelvic fractures and associated injuries. There are several systems for classifying pelvic fractures, according to anatomical patterns, mechanisms of injury, resulting instability requiring surgery. The most frequently used is that of Young and Burgess. For evaluation, one should start with the ABCDE, airway, breathing, circulation, disability, and exposure and integrate a complete traumatologic evaluation. To determine whether there is pelvic instability, the anteroposterior and lateral compression test is performed for one occasion, generating internal and external rotation of the pelvis. The spine and extremities should be well assessed with an adequate neurovascular examination and a thorough neurological examination. In pelvic fractures, management and treatment begins with ABCDE. Followed by stabilization of the patient, a multidisciplinary approach is required. External or internal fixation can be performed to stabilize the pelvis, its use and recommendation usually vary according to the characteristics of each fracture, the associated injuries and the instability of the pelvic ring. Pelvic trauma with involvement of the acetabulum and injuries to the genitourinary system should not be underestimated.  Complications include infection, thromboembolism, malunion and pseudarthrosis.