Types of pelvic injury

The pelvis

The pelvis is a ring made up of two bones joined at:

  • the back by the sacrum (tail bone), which is the lowest part of the spine
  • the front by the pubis symphysis (a cartilage joint).

The pelvis protects:

  • the bladder
  • the bowel
  • the organs of sexual reproduction
  • the blood vessels and nerves which go to your legs.

When walking and sitting your body weight is transmitted through the pelvis. 

After all pelvic fractures the pelvis can have a range of stability, from broken but completely stable to completely unstable. The stability of your pelvis depends partly on the direction in which it was broken, and partly by the amount of force that broke it. Not all fractures need an operation.

Types of pelvic injury

Pelvic injuries are usually caused by significant trauma, such as road traffic collisions, falls from height or a crush injury.  Due to the location of the pelvis, injuries to other structures, such as major blood vessels, the bladder and/or the bowel may occur. This means that the management and long term recovery from pelvic injuries can be complicated. 

The bony pelvis is like a ring, with three main joints (a symphysis pubis at the front and two sacroiliac joints at the back) which are held together by strong ligaments. If the ring is ‘disrupted’ due to trauma, the integrity of the pelvis may be altered. This may require an operation, or several operations to bring the pelvis back to its normal ‘pre injury’ state. There are differing types of pelvic injuries, and the treatment required will depend on the extent of the injury and which other structures are injured.

Anterior-posterior (AP) compression fractures

This type of injury results causes a widening of the pelvic ring, as illustrated below.  Widening of the sacroiliac (SI) joints at the back of the pelvis can also occur, causing internal bleeding.

Lateral compression injury

An impact from the side creates lateral compression fractures, as illustrated below. This type of pelvic injury may cause displaced fractures of the pubic bone and there is a risk of broken bone causing damage to the underlying organs such as the bladder.

Vertical shear injury

The high energy shearing force that causes this kind of injury causes major disruption to the pelvic ring, the SI joints, ligaments and blood vessels (see illustration below). This may leads to major pelvic injury instability and severe internal bleeding. 

Complex pattern injury

When pelvic injuries involve a combination of two or more of the fracture types described above, these are classified as complex pattern injuries.

Treatment of pelvic injuries

The first line treatment for pelvic injuries is to assess for and treat internal bleeding. The patient may require a procedure called an angiogram to detect exactly where the bleeding vessel is, and then ‘embolisation’ to control the bleeding. Sometimes if the patient has lost a lot of blood they will need to go directly to the operating theatre to have the pelvis ‘packed’ to prevent any further blood loss. This is a temporary procedure which is usually followed by a second operation in the days following the injury. Once the bleeding has been controlled and the patient is stabilised, the bony injuries can then be fixed by a specialist orthopaedic team.


In the immediate postoperative period your hospital team will work to manage your postoperative pain, care for your surgical wounds and assist you with your daily needs. They will also show you some exercises you can do to aid your recovery. You may be discharged from the hospital to your home or you may be transferred to your local hospital for further rehabilitation.  The planning arrangements for your discharge are started when you are admitted to the ward. Click here for more information about going home after a pelvic injury

Following surgery for a pelvic fracture, your consultant will normally prescribe how much weight you can put through your legs.  You may be asked to be non-weight bearing through one leg or hip and so you will need to use crutches to mobilise.  A physiotherapist will teach you to do this.  You may need to use crutches for a period of up to eight weeks or longer.  If you have other injuries, your consultant may ask you to not weight bear at all on your legs whilst your injuries heal.  In this case, you will need to use a wheelchair for a short period of time.  Mobility is reviewed on an individual basis when you are seen in the outpatient clinic and have had an x-ray. Click here for more information about pelvic surgery.

The majority of patients resume a normal sex life once the pelvic fractures have healed, though remember the amount of weight you have been asked to restrict through your hip and leg also applies to any sexual position.  Please discuss this with your orthopaedic consultant so you can be correctly counselled.  Most female patients will have no problems with fertility, though there is a higher percentage chance (30% more than normal) of a woman having a caesarean section following pelvic fracture.  If you have experienced damage to your bladder, rectum or vagina at the time of your injury, you may have problems with sexual dysfunction. Sometimes pelvic injury can cause pain during intercourse for women and erectile dysfunction in men. Your consultant will advise you of this and can refer you to the most appropriate team to help you.  Click here for more information about related injuries and possible complications following pelvic surgery.

Returning to work will depend on a number of factors; your occupation, your injuries and the surgery undertaken.  Most patients find they are able to start sports after four to six months once fully healed, but your consultant will advise you based on your specific injuries and surgery when you come back for your outpatient appointment. 

(Much of the Content in the pelvic injuries section has been provided by St Georges' University Hospitals NHS Foundation Trust, Major Trauma Therapy Team, @STGTraumaPTOT)