What is the difference between a pelvic fracture and a hip fracture?

Pelvic Fracture vs Hip Fracture: A Simple Explanation

Pelvic fractures involve breaks in the bones of your pelvis (the bowl-shaped ring of bones in your lower body), while hip fractures are breaks specifically in the upper part of your thigh bone (femur) where it connects to your pelvis.

Key Differences

Location

• Pelvic fracture: Breaks in the pelvic ring bones (ilium, ischium, pubis, or sacrum)
• Hip fracture: Breaks in the upper femur (thigh bone), including the femoral head, neck, or trochanteric region 1, 2

Mechanism of Injury

• Pelvic fracture: Often high-energy trauma (vehicle crashes, falls from height) in younger patients; can be low-energy falls in elderly with osteoporosis 3
• Hip fracture: Usually low-energy falls in elderly patients with osteoporosis; 80% occur in women with average age of 80 years 2

Clinical Presentation

Pelvic Fracture:

• Pain in the pelvic region
• Possible instability of the pelvic ring
• May have significant internal bleeding (life-threatening)
• Patient often cannot bear weight
• May have associated injuries to bladder, urethra, rectum, or blood vessels 1, 4

Hip Fracture:

• Pain specifically in the groin area
• External rotation and shortening of the affected leg
• Unable to bear weight
• Limited hip mobility 2

Assessment Differences

For Paramedics

Pelvic Fracture Assessment:

• DO NOT palpate or "spring" the pelvis - this can worsen bleeding 5
• DO NOT log roll the patient - can disrupt clots 5
• Look for mechanism of injury suggesting pelvic trauma
• Apply pelvic binder around greater trochanters if suspected 4
• Assess for signs of shock (may lose significant blood into pelvic cavity)
• E-FAST ultrasound may be used to identify associated injuries 4

Hip Fracture Assessment:

• Observe for external rotation and shortening of leg
• Pain with minimal movement
• Inability to lift straight leg
• Usually less concern for massive hemorrhage compared to pelvic fractures 2

Imaging

• Initial imaging for both: AP pelvis radiograph 1
• Hip fracture: AP pelvis plus cross-table lateral view of the affected hip 1
• Pelvic fracture: CT scan is gold standard (100% sensitivity/specificity) for stable patients 1
• Occult fractures: MRI without contrast when radiographs are negative but clinical suspicion remains high 1, 4

Management Differences

Pelvic Fractures:

• Unstable patient: External compression with pelvic binder, fluid resuscitation, possible angioembolization 4
• Stable patient: Classification using Young-Burgess or Tile system to guide treatment 4
• Treatment: May require external fixation or ORIF depending on stability 4, 6

Hip Fractures:

• Treatment: Almost always surgical unless significant comorbidities 2
• Prophylaxis: Antibiotics (especially against S. aureus) and thromboembolic prophylaxis 2

Mortality Risk

• Pelvic fractures: Higher mortality with unstable fractures due to hemorrhage risk 7
• Hip fractures: Significant mortality (22% for women, 33% for men at 1 year) 2

Remember: For suspected pelvic fractures, immobilize and transport rapidly. For hip fractures, immobilize the leg in the position found and provide pain management.