Open book pelvic fractures are a type of traumatic break that can occur in the pelvic ring. They are a rare, specific type of open fracture that may be life threatening due to the potential bleeding and other injuries that may be present in this area.
A person’s pelvis is the area of their body below their abdomen to the tops of their thighs. The
The bones that comprise the pelvis are a
Blunt force can fracture a person’s pelvic bones. The severity of the fracture depends on the strength of the blunt trauma.
Some internal organs and major blood vessels sit close to the pelvic bones. Therefore, pelvic bone fractures may cause extensive injury or bleeding, which often requires urgent medical attention.
In this article, we will discuss open book pelvic fractures, including causes, symptoms, and treatments.
Doctors can divide pelvic fractures into either open or closed fractures. Open fractures refer to when bone fragments stick out through the skin, while closed fractures describe when the bone does not break through the skin.
An open book pelvic fracture is a specific type of open pelvic fracture where a person has:
High-trauma events often
- car or motorcycle accidents
- crushing accidents
- falls from a significant height, such as a ladder
The most common cause of an open pelvic fracture is a motor accident. A 2020 study suggests that 61% of open pelvic fracture hospital admissions result from motor accidents.
People with open fractured pelvises experience some or all of the following symptoms:
- pain, aggravated by moving their hip or trying to walk
- swelling or bruising in the hip area
- significant bleeding
- broken skin and visible bone fragments
- additional injuries to other parts of their body, such as their head, legs, chest, or abdomen
Doctors or emergency responders first perform a physical examination of a person’s body. They examine a person’s:
Doctors will also check for:
- any damage to a person’s nerves by assessing if they can move their ankles and toes and feel sensation on the bottoms of their feet
- any other injuries to other parts of a person’s body
- a person’s degree of blood loss, using a complete blood count
If doctors suspect a pelvic fracture, they may order imaging scans, such as:
- X-ray scans to help doctors find out how displaced a person’s pelvic bones are
- computed tomography (CT) scans to help determine the specific pattern and extent of a person’s fracture
- magnetic resonance imaging (MRI) scans to check for fractures that other scans cannot detect
Open book pelvic fractures can be very serious injuries. Because an open fracture breaks a person’s skin, they are more at risk of skin and bone infections. People with open fractures are also at risk of severe blood loss.
Due to the nature of this injury, early identification and treatment are vital for improving outcomes.
As people with open book pelvic fractures may be rapidly losing blood, emergency responders may use a
Emergency responders will then transfer the person to an emergency room or ICU. Doctors then perform urgent patient assessments and treatment protocols there. These protocols can include:
- damage control surgery
- using c-clamps to prevent bleeding
- applying stabilizing frames to hold a person’s bones in their proper positions
- bowel diversion, using surgery to allow a person’s stool to leave their body without passing through the injured pelvic area
- blood transfusions
- pelvic angiography, which uses X-rays to check a person’s blood vessels for damage
- applying a pelvic binder if emergency responders have not already done so
debridement— removing dead tissue from a person’s wounds
People with pelvic fractures may have multiple injuries, requiring care from different kinds of medical specialists. This can involve lengthy hospital stays.
Ongoing treatment for a person’s open pelvic fracture normally involves different types of
People who have had an open pelvic fracture often develop lethal complications,
Other complications can include:
- organ failure
- damage to a person’s nerves or blood vessels
- blood clots
- brain damage
- bones healing in the wrong position
- bones not healing
People may have long-term complications after their injury has healed,
- dyspareunia, or painful sexual intercourse
- higher likelihood of requiring a cesarean section when delivering a baby
- sexual dysfunction
- erectile dysfunction
- walking with a limp for up to a year
- pain or impaired mobility due to nerve damage
People who sustain open book pelvic fractures in high-energy accidents may have severe and life threatening complications. These can include bleeding, internal injuries, and infections, as well as long-term complications.
It is, therefore, essential that a person receives prompt treatment after sustaining an open book pelvic fracture. Modern medical techniques and protocols have improved survival rates for people with these injuries.