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# Pelvic fracture

A pelvic fracture is a break in the ring of hip bones. High-energy breaks can bleed heavily and injure the bladder or urethra.

Updated 2026-11-01

## Structures involved

Tap one to see what it is and open it in 3D.

- [Hip bone](https://durgical.com/en/anatomy/hip-bone/)
- [Sacrum](https://durgical.com/en/anatomy/sacrum/)
- [Pubic symphysis](https://durgical.com/en/anatomy/pubic-symphysis/)
- [Urinary bladder](https://durgical.com/en/anatomy/urinary-bladder/)
- [Sacroiliac ligaments](https://durgical.com/en/anatomy/sacroiliac-ligaments/)
- [Internal iliac arteries](https://durgical.com/en/anatomy/internal-iliac-artery/)
- [Internal iliac veins](https://durgical.com/en/anatomy/internal-iliac-vein/)
- [Membranous urethra](https://durgical.com/en/anatomy/intermediate-part-of-male-urethra/)
- [Urethra (female)](https://durgical.com/en/anatomy/female-urethra/)
- [Rectum](https://durgical.com/en/anatomy/rectum/)
- [Vagina](https://durgical.com/en/anatomy/vagina/)
- [Coccyx](https://durgical.com/en/anatomy/coccyx/)

## Why it happens

- [Hemorrhage: petechiae, purpura, ecchymosis, hematoma, and what blood loss does](https://durgical.com/en/general-pathology/hemorrhage-petechiae-purpura-ecchymosis-hematoma-and-what-blood-loss-does/)
- [Shock physiology](https://durgical.com/en/physiology/shock-physiology/)
- [Bone tissue: cells, compact and spongy bone](https://durgical.com/en/histology/bone-tissue-cells-compact-and-spongy-bone/)

## What it is

Fracture of the bony pelvic ring (hip bones, [sacrum](https://durgical.com/en/anatomy/sacrum/), [pubic symphysis](https://durgical.com/en/anatomy/pubic-symphysis/) and sacroiliac joints). Low-energy fractures in older adults are often stable; high-energy fractures can disrupt the ring and cause life-threatening bleeding.

## Who gets it

Pelvic fractures are a small share of all fractures but are frequent in polytrauma from motorcycle crashes, pedestrian injuries and falls from height, all common in Colombia. In older adults with osteoporosis they also follow simple falls.

## Causes

- Motorcycle and car crashes, pedestrians struck
- Falls from height
- Crush injuries
- Low-energy falls in older adults with osteoporosis
- Avulsion fractures in adolescent athletes

## Risk factors

- High-energy mechanism
- Osteoporosis and older age
- Motorcycle riding
- Work at height

## Pathophysiology

The pelvis is a ring, so a displaced break usually occurs in two places. Disruption, especially open-book injuries, increases pelvic volume and tears the posterior venous plexus, cancellous bone and sometimes branches of the [internal iliac arteries](https://durgical.com/en/anatomy/internal-iliac-artery/); most bleeding is venous and retroperitoneal. Bone fragments and shearing can injure the bladder, urethra, rectum, vagina and lumbosacral nerves.

## Classification

- Stable versus unstable ring (mechanically and haemodynamically)
- Young–Burgess by mechanism: lateral compression, anteroposterior compression (open book), vertical shear, combined
- Tile: A stable, B rotationally unstable, C rotationally and vertically unstable
- Open versus closed fracture
- Acetabular fractures are classified separately

## Symptoms and signs

- Pain in the pelvis, groin or lower back that worsens with movement
- Inability to walk or bear weight
- Bruising or swelling of the perineum, [scrotum](https://durgical.com/en/anatomy/scrotum/) or flank
- Leg-length difference or rotation without a hip fracture
- Signs of shock

## Red flags

- Haemodynamic instability (massive retroperitoneal bleeding)
- Blood at the urethral meatus, a high-riding [prostate](https://durgical.com/en/anatomy/prostate/) or perineal haematoma (urethral injury)
- Inability to pass urine or haematuria (bladder injury)
- Blood on rectal or vaginal examination (open fracture)
- Leg weakness or numbness (lumbosacral plexus injury)

## Diagnosis

**Clinical**
ATLS primary survey; the [pelvis](https://durgical.com/en/anatomy/region/pelvis/) is assessed once and gently, without repeated rocking that can restart bleeding. Look for perineal bruising, urethral blood and leg deformity, and examine the [rectum](https://durgical.com/en/anatomy/rectum/) and [vagina](https://durgical.com/en/anatomy/vagina/) for open injury.

**Tests**
Haemoglobin, blood group and crossmatch, lactate and base deficit, coagulation tests and urinalysis for blood.

**Imaging**
Anteroposterior pelvic X-ray and eFAST in unstable patients. Contrast CT defines the fracture and shows arterial blush in stable patients. Retrograde urethrogram before any bladder catheter when urethral injury is suspected; CT or conventional cystography for bladder injury.

## Differential diagnosis

- Hip fracture or dislocation
- Acetabular fracture
- Lumbar [spine](https://durgical.com/en/anatomy/region/spine/) fracture
- Intra-abdominal bleeding as the source of shock

## Goal of treatment

Close the pelvic volume and stop bleeding, identify associated urological, rectal and abdominal injuries, then restore a stable ring that allows early mobilisation.

## Treatment

**Acute**
Pelvic binder (or a sheet) centred on the greater trochanters, early balanced blood transfusion and tranexamic acid in bleeding patients.

**Procedure**
Angioembolisation for arterial bleeding seen on CT, preperitoneal pelvic packing when angiography is not available or bleeding persists, and endovascular aortic balloon occlusion as a bridge in selected centres.

**Surgical**
Temporary external fixation for unstable rings, later definitive fixation (open reduction and internal fixation) once the patient is physiologically stable.

**Conservative**
Stable low-energy fractures: pain control, early walking with aids as tolerated and thromboprophylaxis.

**Follow-up**
Nursing priorities: vital signs and signs of ongoing bleeding, binder position and [skin](https://durgical.com/en/anatomy/skin/) checks, no urethral catheter until urethral injury is excluded, neurovascular checks of the legs and DVT prevention.

## Complications

- Haemorrhagic shock and death
- Urethral stricture, erectile dysfunction and incontinence
- Bladder rupture
- Deep vein thrombosis and pulmonary embolism
- Infection, especially in open fractures
- Malunion, nonunion, chronic pain and leg-length discrepancy
- Lumbosacral nerve injury

## Prognosis

Stable fractures usually heal well. Mortality in unstable high-energy fractures is driven by bleeding and associated injuries; survivors may have long-term pain, gait problems and urological or sexual dysfunction.

## Prevention

- Road safety and motorcycle protective equipment
- Fall prevention and osteoporosis treatment in older adults
- Safety measures for work at height

## Test yourself

Think of the answer, then tap the question to see it.

## What is the first measure to reduce bleeding from an unstable pelvic fracture in the emergency department?

A pelvic binder (or sheet) centred over the greater trochanters to close the pelvic volume, along with blood transfusion.

## Where does most bleeding in pelvic fractures come from?

The posterior pelvic venous plexus and the fracture surfaces; only a minority is arterial (branches of the internal iliac artery).

## Which signs suggest a urethral injury and what must be avoided?

Blood at the meatus, a high-riding prostate or perineal haematoma; a urethral catheter should not be placed until a retrograde urethrogram excludes injury.

## Which pelvic fracture pattern widens the pubic symphysis and is called open book?

Anteroposterior compression injury.

## What are the options when a pelvic fracture keeps bleeding despite a binder?

Angioembolisation for arterial bleeding, preperitoneal pelvic packing and external fixation.

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## Related conditions

- [Major trauma (polytrauma): ATLS primary survey](https://durgical.com/en/conditions/major-trauma-atls-primary-survey/)
- [Hypovolaemic shock](https://durgical.com/en/conditions/hypovolaemic-shock/)
- [Blunt abdominal trauma](https://durgical.com/en/conditions/blunt-abdominal-trauma/)
- [Deep vein thrombosis](https://durgical.com/en/conditions/deep-vein-thrombosis/)
- [Pulmonary embolism](https://durgical.com/en/conditions/pulmonary-embolism/)
- [Hip dislocation](https://durgical.com/en/conditions/hip-dislocation/)
- [Femoral Neck Fracture](https://durgical.com/en/conditions/femoral-neck-fracture/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Pelvic trauma: WSES classification and guidelines](https://pmc.ncbi.nlm.nih.gov/articles/PMC5241998/) (World Journal of Emergency Surgery, 2017); [Pelvic Fractures - OrthoInfo - AAOS](https://www.orthoinfo.org/en/diseases--conditions/pelvic-fractures/) (American Academy of Orthopaedic Surgeons (OrthoInfo), 2026).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/conditions/pelvic-fracture/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/pelvic-fracture/