Pelvic fracture

Pelvic fracture

The pelvis is the sturdy ring of bones located at the base of the spine, acting as the anchor point for the hindlimbs. It is composed of three pieces, the ilium, the ischium, and the pubis. The ilium connects the pelvis on either side to the sacral spine (the areas where they join are termed the left and right sacroiliac joints), and both the ilium and the ischium form a cup-like area (acetabulum) for the femur/thigh bone to slot into, forming the hip joint.

Fracture of the pelvis is usually caused by a major extrinsic force (usually following a road traffic accident) and depending on the area that is fractured, varying degrees of lameness, pain, and injury occur. Consequently, concurrent injury is usually present and can be quite serious.

Pelvic fractures are common in both dogs and cats following trauma and early treatment is needed in order to ensure a good prognosis for any pet affected.

How are pelvic fractures diagnosed?

Pelvic fractures are suspected if there is a history of trauma, hindlimb lameness or paresis (weakness). On clinical examination obvious instability or pain upon palpation may be detected. Radiography is required to classify the injuries accurately and allow a treatment plan to be formulated. Sometimes, in cases of severe or multiple pelvic injury, advanced imaging such as CT scans may be necessary to evaluate the extent of the injuries.

How are pelvis fractures treated?

Treatment of pelvic fractures varies based on:

• the area/areas injured (often pelvic fracture occurs in multiple areas),
• the degree of displacement of the fracture
• the extent or presence of concurrent internal injury (abdominal in particular),
• the duration of the fracture i.e. how long since it occurred,
• the patient’s age, general body condition and temperament.

The most important thing is to evaluate the entire patient, as pelvic fractures may not be the only injury present. Many patients with pelvic fractures have concurrent, more immediately life-threatening injuries which need to be prioritised prior to pelvic fracture repair. Direct or indirect bladder injury (through rupture or damage to its neurological supply) are often present along with pelvic injury.

Conservative management (cage rest, pain relief and time) may be a valid option for some pelvic fractures. Other times, internal reduction and stabilisation is necessary often using bone plates and screws.

Fractures of the acetabulum are difficult to repair and usually require surgery to attempt to reconstruct the hip joint surface or salvage surgery to preserve limb function.

What is the long-term prognosis for my pet following pelvic fracture?

With early and appropriate surgical management of pelvic fractures the outcome is usually good to excellent. Conservative management can also lead to very good outcomes but there may be slightly less predictability in progress during the rehabilitation period.