Fractures of the Pelvis


Key Points

Careful of internal organs in the abdomen and chest need to be assessed in patients that have pelvic fractures

Evaluation of nerve function is critical in patients having pelvic fractures

Surgical repair of pelvic fractures results in quicker return to function and less pain during the healing phase

Prognosis is usually good following surgery

 

Anatomy

  • The pelvis is like a box
  • The front of the pelvis is attached to a portion of the spine called the sacrum (labeled S) by a fairly immoveable sacroiliac joint
  • The ilium (labeled l) is the largest weight-bearing portion of the pelvis
  • The hind limbs are attached to pelvis at the acetabulum (hip joint) – labeled A
  • The ischium (labeled Is) is the nonweight-supporting portion of the pelvis
  • The sciatic nerve, which is the primary nerve of the back leg, runs along the inner side of the ilium and over the top of the ischium just behind the acetabulum

Fig 1

 

Fractures

  • Usually at least two fractures of the pelvis or a single fracture and a dislocation of the sacroiliac joint occur; rarely a single fracture is present
  • Fractures of the ilium and acetabulum can cause nerve injury
  • Weight is transmitted from the hind limb into acetabulum, ilium and sacroiliac joint, then into the spine; as a result, a fracture or dislocation of any of these usually requires surgery
  • Fractures of the acetabulum need to be repaired as perfectly as possible in order to minimize development of arthritis of the hip joint
  • Fractures of the ischium usually do not require repair
  • Dogs that have pelvic fractures frequently also have:
    • Chest trauma such as bruised lungs, ruptured lungs, rib fractures, tear of the diaphragm, bleeding into the chest
    • Bleeding into the abdomen due to trauma to the liver or spleen
    • Ruptured bladder
    • Abdominal wall hernia (prepubic tendon rupture)

 

Surgery

  • Dislocation of the sacroiliac joint is repaired using a large screw and pin
  • Fractures of the ilium are usually repaired using a plate and screws
  • Fractures of the acetabulum are repaired with:
    • A plate and screws

    OR

    • Screws, a pin, wire, and bone cement
  • Fractures of the back 1/3 of the acetabulum can be left to heal with no surgery, but ideally all acetabular fractures should be repaired
  • If the sciatic nerve is not working properly due to a pelvic fracture, surgery should be done on an emergency basis
  • If severe trauma to the chest has occurred, a number of days may be needed before the pelvis can be repaired so that anesthesia can be safer
  • If the bladder has been ruptured, this is usually repaired first
  • Fig 2 shows a right ilial shaft fracture; note the displacement of the pelvis under the spine where the sciatic nerve is located (you can’t see the sciatic nerve on x-rays); Fig 3 shows the pelvis following repair of the fracture with excellent alignment of the pelvis.
  • To see a sacroiliac luxation repair look at the femoral fracture repair article.

Fig 2

Fig 3

 

Aftercare

  • Limit activity until the fractures have healed
  • Provide a soft bed to prevent bed sores
  • Turn your pet from side to side if needed
  • Check the incision for infection
  • Use a towel as a sling to support weight when taking your pet outside for elimination purposes

 

Potential complications

  • Sciatic nerve damage
  • Nonhealing of the fractures
  • Breakage of the plates or screws
  • Infection
  • Anesthetic death
  • Pregnancy should be avoided as natural delivery of the puppies may not be possible due to scar tissue or callus formation in the pelvic canal (C-section is also an option if breeding is a must)
  • Chronic constipation if a lot of callus or scar tissue develops in the pelvic canal
  • Entrapment of the urethra (tube from the bladder for urination) by fracture fragments

 


← Back to all Pet Conditions