They usually affect the pubic bone and cause exercise-related pain which gets gradually worse, but they do not usually prevent exercise. Pelvic stress fractures are caused by repeated stresses to the bone, usually due to sport. A pelvic avulsion fracture may also be caused by a car accident. Examples are hurdling, sprinting, long-jumping, and soccer (particularly miskicks that hit the ground). These types of fractures typically occur during sports that involve speed and sudden stops, particularly in young people who are still growing. This most commonly occurs at bottom of the ischium where the big hamstring muscles are attached, or on the front of the ilium where one of the large quadriceps muscles attaches. What causes pelvic avulsion fractures?Ī pelvic avulsion fracture occurs when the tendon of a muscle comes away from the bone, taking a small chip of bone with it. For this reason painful but stable fractures are more common in elderly people who tend to have 'thinner' bones, and who are sometimes prone to falls. Less severe fractures which involve undisplaced fractures can occur after falls or trips, particularly if the bones are 'thin' (osteoporosis). Pelvic fractures caused by high-force or high-speed injuries are often unstable and they need urgent hospital treatment. Major pelvic fractures are caused by major trauma such as road traffic accidents, crush injuries (for example, being run over by a car or rolled on by a horse) and falls from height. Pelvic fractures therefore range enormously in severity, from fairly minor to life-threatening. The seriousness of a pelvic fracture depends on how many bones are broken and how badly, and on what injuries may have occurred to the organs inside the pelvis. Open fractures are more serious because infection can easily reach the wound, which may already be contaminated from the injury. Pelvic fractures, whether stable or unstable, can also be divided into 'open' fractures, in which injuries to the skin mean that the broken bones are visible, or 'closed' fractures, in which the skin is not broken. These include 'open book' fractures, when the pelvis is broken at the front and the back by severe force from the front, and lateral (or sideways) force fractures which often fracture the pubic rami and the sacroiliac joints, sometimes also involving the hip socket. There are some typical patterns of unstable fractures. They may also involve direct damage to the internal organs. These injuries involve much more bleeding than stable fractures, as the separation of the broken bones allows them to bleed much more freely. This type of fracture is more likely to occur after high-impact injury and there may, therefore, be other associated injuries. Unstable fracture: this usually occurs when there are two or more breaks in the pelvic ring and the ends of the broken bones move apart. Pelvic avulsion fractures (in which a fragment of bone is broken off by the pull of a muscle) and pelvic stress fractures (hairline cracks which do not extend all the way across the bone) are also types of stable pelvic fractures. In each of these cases the other bones are intact and will keep the bony ring of the pelvis together. Usually only one bone is affected, with a single fracture.Ĭommon fracture patterns include: breaks across the top of one ilium, cracks to the pubic ramus on one side, or cracks in the sacrum. Stable fracture: the broken bones are still properly lined up, so that the ring has kept its shape. Perhaps the most important way of classifying pelvic fractures is into stable or unstable fractures.
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