In France, approximately 10,000 pelvic fractures are recorded each year in people over 60, mostly women. These fractures, often linked to osteoporosis, can lead to a decrease in independence and impact life expectancy, similar to hip fractures. Fall prevention is a major factor in reducing these accidents. Advice from Dr. Pomme Jouffroy, surgeon.
Of the 15,000 pelvic fractures, nearly 10,000 affect people over 60. "In two out of three cases, it involves women. These fractures mainly affect frail elderly people," explains Dr. Pomme Jouffroy, orthopedic surgeon and traumatologist at Saint-Joseph Hospital in Paris.
What is a pelvic fracture?
The pelvis is comparable to a very rigid ring, like a bracelet. This bony structure forms what is called the pelvic ring. It has three components: the sacrum at the back , which connects the pelvis to the spine, and the two iliac bones, or hip bones, on the sides, which meet at the front at the pubic symphysis. "When it breaks, it has to break in two places. A pelvic fracture is generally associated with an injury at the front and an injury at the back, especially in older people," explains Dr. Pomme Jouffroy.
When the fracture is located at the front of the pelvic ring, it may be a fracture of the pubic symphysis or, more frequently in the elderly, a fracture of the obturator foramen, which corresponds to the anteroinferior portion of the hip bone. At the back, fractures most often involve the sacrum, and more rarely the sacroiliac joints.
There are also fractures that do not directly affect the pelvic ring but the acetabulum, that is, the joint cavity into which the head of the femur fits to form the hip. These fractures involve the joint itself and require specific treatment.
Pelvic fracture in the elderly: what are the causes?
Pelvic fractures can occur after high-energy trauma, such as a bicycle or car accident, even in physically fit older adults. "In this case, the pelvis is often significantly displaced," explains Dr. Jouffroy. They can also result from low-energy trauma, such as a fall from standing height. These fractures, much more common in frail older adults, are generally minimally displaced and often affect bones weakened by osteoporosis , such as the sacrum or pubic rami. This explains why pelvic fractures are more frequent in women, who are more susceptible to this bone fragility.
Pelvic fracture: what are the symptoms and how is it diagnosed?
The most common signs of a pelvic fracture are pain localized in the groin, buttocks, or lower back, which worsens when standing or walking, as well as difficulty standing or taking a few steps. Pain may also be present when pressure is applied to the pubic bone or sacrum. "In cases of obturator foramen fractures, some fractures extend into the joint cavity. The fracture bleeds, there is blood in the joint, and the pain when weight-bearing is then more intense," explains the doctor. In some cases, swelling or bruising may appear. "The pelvis may move slightly; it is somewhat mobile," adds Dr. Pomme Jouffroy.
The fracture bleeds; there is blood in the joint, and the pain when bearing weight is then more intense. Dr. Jouffroy
Pelvic fractures are diagnosed using imaging tests. Pelvic X-rays can visualize some fractures, but they don't always detect sacral fractures or minimally displaced fractures. A CT scan is the gold standard, allowing for a precise assessment of the fractures. The Rommens classification determines the severity and prognosis to select the most appropriate treatment.
Treating a pelvic fracture with or without surgery?
A pelvic fracture doesn't always require surgery. "When there is significant displacement or very severe pain, surgery may be necessary to stabilize the fracture ," explains the orthopedic surgeon. Today, percutaneous surgery allows for the placement of fixations without fully opening the pelvis. "This greatly relieves pain for elderly people when the fracture is very painful," adds Dr. Jouffroy. Hospitalization typically lasts three to five days. Afterward, the patient can go to a rehabilitation center or return home if they are not isolated.
In most cases, approximately 95% of pelvic fractures, functional treatment is sufficient. This primarily involves relieving pain with appropriate analgesics and maintaining the patient's mobility as much as possible, using suitable walking aids and gradually increasing weight-bearing. Hospitalization typically lasts only a few days.
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