The pelvis is a bony, ring-like structure at the lower end of the body. The pelvic bone is a large bone with two parallel halves, each half of which is located on one side of the body and together make the complete pelvis. Each half of the pelvis on each side of the body is composed of three bones called the ilium, ischium and pubis. The three bones of the ilium, pubis and ischium are separate until puberty and are held together by cartilage. Finally, with age, these three bones are connected and form a single bone. Ligaments are strong connective tissues that connect the pelvis to a large triangular bone called the sacrum at the bottom of the spine. This junction creates a bowl-like cavity under the ribcage. Pelvic injuries Pelvic injuries have a wide range. Injuries to the bones, joints or soft tissues of the pelvis. These injuries may occur in car accidents, falls, or other traumatic events. Although some hip injuries are minor and do not require treatment, others can be life-threatening. Classification of pelvic injuries To diagnose pelvic injuries in medicine, these injuries are usually classified into four groups: - Dislocations with fractures, in which the bones of the pubic or sacral joint are broken and dislocated. - Permanent injury in which the bone is cracked and no longer united, while the hip ring remains intact. - Unstable injuries in which the bones of the pelvic ring break. The fracture may be in one or more places and the bones may be displaced. - Damage to the lower part and edges of the acetabulum, which in some cases is associated with dislocation of the hip joint. Classification and types of hip fractures Hip fractures are generally classified into three types depending on the degree and severity of the fracture: ### Grade A fractures Grade A fractures are stable and partial fractures. Grade A fractures may include olesion fractures, such as a dislocation of the rectus femoris muscle (right thigh muscle) and a fracture of any of the iliac bones. ### grade B fractures In grade B fractures, the fracture area is unstable during rotation. Grade B fractures often result in widening of the SI joints and separation of the symphysis pubis (pubic attachment). ### grade C fractures In grade C fractures, the fracture area becomes unstable during rotational and vertical movement, which also makes the pelvic ring completely unstable. The injuries of this type of fracture are very severe and the mortality rate and complications caused by them are high. Types of hip fractures Because the pelvis is a bony ring, a fracture caused by a severe injury to one part of this structure can cause a similar fracture in the opposite point in the pelvic ring. There are several common patterns of hip fractures depending on the direction and severity of the impact. Perhaps the most important way to classify hip fractures is to divide them into stable or unstable fractures. Most hip fractures are stable. ### Stable fracture In a stable fracture, although the bones are broken, they are still in place, so that the ring retains its shape. Usually, the fracture is only in one bone. Common patterns in this type of fracture are: - Fracture at the top of one of the ilium bones - A crack on one side of the pubic ramus - Crack in the sacrum In all these cases, the other bones are healthy and keep the pelvic ring together. Hip avulsion fractures (in which a piece of bone breaks due to muscle tension) and hip stress fractures (hairline cracks that are not stretched along the entire length of the bone) are also types of stable hip fractures. Read more: hip joint replacement surgery in Shiraz ### Unstable fracture In this type of fracture, there are usually two or more fractures in the pelvic ring and the ends of the broken bones are separated. This type of fracture is more likely to occur after a severe injury and therefore there is a possibility of other associated injuries as well. Bleeding in these injuries is much more than in stable fractures, because the broken and separated and displaced bones can cause damage to the vessels and bleeding. There is also a possibility of direct damage to internal organs. Unstable fractures have several common patterns, including "open" fractures that occur in the front and back of the pelvis as a result of severe force applied to the front of the pelvis (for example, in a severe road accident) and fractures caused by lateral force (or from the side) to the pelvis, which often causes fractures of the pubic bones, rami, sacroiliac joints, and sometimes damage to the ball of the hip joint. ### Open and closed fractures Pelvic fractures, whether they are stable or unstable, are also classified into "open" and "closed" fractures, so that in "open" fractures there are skin injuries and in "closed" fractures the skin is not torn. Open fractures are more serious because the wound may easily become infected due to contamination. Objectives of hip fracture treatment As with any fracture, the main goal in the treatment of acetabular and hip fractures is to return the patient to the functional level before the injury, as much as possible, so that the person can resume their daily, work and recreational activities. Doctors, nurses and rehabilitation specialists design a course of treatment to restore strength and range of motion before the injury. To achieve these goals, proper bone alignment during healing is essential. In cases of acetabular and hip fractures, displacement is often present. In other words, the bones are not in the right position and need to be realigned or put back into place. Doctors use the term ablation to describe this process. If the joint surfaces do not heal properly, the cartilage covering the joint wears away. These conditions will set the stage for severe joint arthritis, loss of mobility, reduced function, and pain in the future. Read more: hip and thigh orthopedics in Shiraz Non-surgical pelvic treatments Pelvic fracture treatment is based on several factors, including the type of fracture, the stability of the pelvis, and the amount of displacement of the bones. The orthopedic surgeon will diagnose the problem according to the information obtained from the physical examination, plain radiographs and CT scan. Cases of stable hip fractures—without displacement or dislocation—are the most likely candidates for nonsurgical treatment. Some may require closed reduction (realignment without open surgery) under anesthesia with or without external fixation. Some cases of acetabular fracture can also be treated non-surgically. Typically, these nonsurgical treatments are chosen for patients who do not have displaced fractures and/or are unable to tolerate surgery, such as those with significant physical problems, infection, or severe osteoporosis. Closed reduction is performed either by manipulation, while the patient is under anesthesia, or by traction on the patient's body. Pelvic surgical treatment Bone realignment may be done as an open reduction, where the orthopedic surgeon makes an incision to directly manipulate the bone, or as a closed reduction, where no incision is necessary. After the bones are realigned, the surgeon stabilizes the bones internally or externally so that the bones remain in the proper position during the healing process. For this purpose, metal devices such as wires, pins, screws and plates are used. One or more surgical procedures are sometimes needed to treat a hip fracture. The surgeon may begin with an external fixation technique (Ex-Fix) and open or closed reduction, and then fix the bones in place using an external fixator or frame. This is done by inserting pins into the bone on both sides of the fracture. These pins are then attached to rods outside the skin and form a frame. While the Ex-Fix technique is sometimes the only procedure needed to repair a hip fracture, some patients require one or more additional surgeries to fix the bones internally using plates and screws. Depending on the location and complexity of the fracture, the surgeon may have to correct the front or back of the hip, or both. Sometimes, a separate operation is needed to treat each affected area. Patients with acetabular fractures often require open fixation with internal fixation (ORIF), especially patients with a displaced joint. The surgeon realigns or reduces the bones as much as possible to prevent post-injury problems, especially arthritis. The bones are firmly fixed with plates and screws to prevent future displacement and enable the rehabilitation process to begin as soon as possible. Acetabular fractures usually do not heal for 5 to 10 days after the injury. Since in this type of fracture, the patient bleeds significantly, the orthopedic surgeon must wait for the patient's body's coagulation mechanisms to activate, which usually takes three to five days. During this period, traction may be used for the patient in order to prevent further damage. Dr. Zohra Eshghi, a specialist in physical medicine and rehabilitation in Shiraz, providing treatment services for skeletal and muscular diseases in Shiraz, to receive an appointment for examination, diagnosis and treatment, contact us and the office using the information on the contact page.