From the Guidelines
The primary distinction between stable and unstable pelvic fractures is rooted in the integrity of the pelvic ring and the resultant clinical implications, with unstable fractures posing a significant risk to morbidity, mortality, and quality of life due to potential for severe bleeding and hemodynamic instability, as highlighted in studies such as 1 and 1.
Key Differences
- Stable pelvic fractures are characterized by their ability to maintain the pelvic ring's integrity, allowing for normal physiological forces without displacement. These are often seen in single breaks or non-weight-bearing areas of the pelvis.
- Unstable pelvic fractures, on the other hand, involve multiple disruptions of the pelvic ring, leading to a compromise in its structural integrity. This type is commonly associated with high-energy trauma and includes patterns like open-book fractures or vertical shear injuries.
Clinical Implications
- Patients with stable fractures generally have a more favorable prognosis, can often bear weight with assistance, and may require only conservative treatment.
- In contrast, unstable fractures are associated with significant displacement, instability, and a higher risk of vascular injury, leading to potential life-threatening hemorrhage. The management of unstable fractures typically involves immediate stabilization and often definitive surgical fixation to restore pelvic integrity.
Management Approach
- The approach to managing pelvic fractures should be multidisciplinary, considering the patient's hemodynamic status, the anatomic impairment of the pelvic ring, and any associated injuries, as emphasized in 1.
- For unstable fractures, the use of angioembolization has been shown to be an effective measure for controlling hemorrhage, especially in cases with arterial sources of bleeding, as noted in 1.
Outcome Considerations
- The choice between conservative management and surgical intervention should prioritize minimizing morbidity, mortality, and improving quality of life.
- Given the potential for severe complications, unstable pelvic fractures necessitate prompt and aggressive management to stabilize the patient and prevent long-term sequelae, underscoring the importance of early intervention as suggested by 1 and 1.
From the Research
Difference between Stable and Unstable Pelvic Fractures
- Stable pelvic fractures are typically caused by low-energy trauma and do not require immediate surgical intervention 2.
- Unstable pelvic fractures, on the other hand, are usually caused by high-impact trauma and require early stabilization to prevent further complications such as neurological or visceral injury, hemorrhage, and long-term deformity and disability 3, 4.
Characteristics of Unstable Pelvic Fractures
- Unstable pelvic fractures often result in significant patient morbidity and mortality, with a high percentage of lesions in other organs such as cerebral, thoracic, and abdominal lesions 2, 4.
- These fractures can lead to massive hemorrhagic shock, with most patients dying within the first hours after trauma 4.
- The management of unstable pelvic fractures requires a multidisciplinary approach, including swift and adequate resuscitation, reversal of shock and acidosis, and rapid control of hemorrhage 2, 5.
Treatment of Unstable Pelvic Fractures
- External fixation is a commonly used technique for the urgent stabilization of unstable pelvic fractures, and can be used as a definitive treatment in most cases 3, 4, 6.
- The use of supra-acetabular pins over iliac crest pins can decrease re-displacement, and the least number of pins for the shortest amount of time is recommended 3.
- Early external fixation (within 7 days) can positively affect hemodynamic stability and is an effective final fixation option for unstable pelvic fractures 6.