Bækkenfrakturer

Bækkenfrakturer, or pelvic fractures, are injuries that involve disruption of the pelvic ring and can range from isolated mild injuries to complex injuries involving the sacrum, acetabulum, and surrounding structures. They typically result from high-energy trauma such as motor vehicle collisions, falls from height, or crush injuries, though older adults with osteoporosis may sustain low-energy fractures. Because the pelvis houses major vessels and pelvic organs, these fractures can be associated with significant hemorrhage and other injuries.

Two primary classification systems help guide management. The Tile system categorizes fractures as A (stable), B (rotationally unstable but partially stable), or C (unstable with both rotational and vertical instability). The Young-Burgess system describes mechanism-based patterns: anterior-posterior compression (APC), lateral compression (LC), and vertical shear (VS). These schemes aid in assessing stability and planning treatment, with unstable or open fractures more likely to require surgical stabilization.

Initial management follows trauma principles (ATLS). A pelvic binder or sheet is applied to reduce pelvic volume and control bleeding, and analgesia and resuscitation are initiated. Imaging generally includes an AP pelvic radiograph and computed tomography to define fracture pattern and assess for intra-abdominal injuries. Hemorrhagic pelvic fractures may need angioembolization for arterial bleeding or interventional/surgical stabilization. External fixation can provide temporary stability in unstable patients, while definitive internal fixation is considered once the patient is hemodynamically optimized. Nonoperative treatment is appropriate for stable, nondisplaced fractures in selected patients.

Complications include life-threatening hemorrhage, vascular or urogenital injuries, nerve impairment, infection, venous thromboembolism, and chronic pain or deformity. Prognosis depends on fracture pattern and associated injuries; rapid stabilization and multidisciplinary care improve outcomes.