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Differentiation of fractures between the young and the old: Why do young people need to experience major trauma to fracture
A pelvic fracture is a break in the pelvic structures, involving a break in the sacrum, hip bones (ischium, pubis, latissimus), or coccyx. Symptoms of this injury often include severe pain during movement, while complications may involve internal bleeding, bladder damage, or vaginal trauma. Common causes of pelvic fractures include falls from heights, car accidents, pedestrians being hit by cars, or direct severe crush injuries. In younger people, fractures usually require significant trauma, whereas fractures can occur in older people after less severe trauma.
Pelvic fractures account for approximately 3% of fractures in adults. Stable fractures generally have a better prognosis, whereas unstable fractures carry a 15% risk of death.
Types and symptoms of fractures
Pelvic fractures are divided into two main categories: stable and unstable. Unstable fractures can be further divided into anterior-posterior compression, lateral compression, vertical shear, and combined mechanism fractures. The main symptom of a fracture is pain, especially worse with movement.
Complications of fractures
Complications of a pelvic fracture may result in excessive blood loss or puncture of other organs, ultimately leading to shock. With high-impact injuries, swelling and bruising are more pronounced, and the severity of the pain varies depending on the extent of the impact and may radiate with movement.
Causes of fractures
Common causes of fractures include falls, car accidents, pedestrian hits, or direct pressure. In younger people, a major traumatic event must occur, whereas in older people, only minor trauma can lead to a fracture.
Physiological mechanisms and diagnosis
The structure of the pelvis is composed of the latissimus (i.e., latissimus wing), ischium, and pubis, forming a complete ring that connects to the sacrum. The destruction of this ring requires considerable energy. If a person is fully alert and has no pelvic pain, medical imaging is not necessary.
Classification of fractures
There are several classification systems for pelvic fractures. The Tile classification system is divided into three categories based on the integrity of the posterior sacroiliac joint: type A (stable), type B (partially unstable), and type C (completely unstable). The Young-Burgess classification is based on the mechanism of injury, including anterior-posterior compression, lateral compression, and vertical shear.
Open fracture
A specific type of pelvic fracture is called an "open book" fracture, which usually results from a severe crush injury. Because these fractures are associated with a higher risk of infection and bleeding, the mortality rate is relatively high.
Precautions
As we age, our bones become weaker and more susceptible to fractures. To reduce the risk of pelvic fractures, appropriate preventive measures should be taken. Various high-energy injuries, such as car accidents or falls from heights, are the main causes of fractures. Therefore, it is crucial to take appropriate protective measures.
TreatmentPelvic fractures are often challenging to treat and may involve surgical or nonsurgical options, depending on the severity of the fracture. In emergency situations, pelvic stabilization is necessary, usually with the use of a pelvic band to reduce blood loss and risk of death. For cases that require surgery, a comprehensive plan is needed based on the type of fracture and other associated injuries.
Prognosis and epidemiology
In the United States, approximately 10% of patients receiving trauma treatment suffer from pelvic fractures. Among them, motorcycle accidents are the most common cause of pelvic fractures.
So, how can we prevent it in our daily lives and protect ourselves from this potential harm?
