Open book pelvic fracture

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  • Results from an anteroposterior compression injury to the pelvis
  • Often seen in elderly falls vs MVA or other high speed trauma
  • Causes disruption of pubic symphysis and the pelvis opens like a book
  • Results in tears of the strong pelvic ligaments that hold the pelvis bones together
  • Large arteries pass near these ligaments and can get torn resulting in massive blood loss

Pelvic fracture types

The skeleton of the human pelvis: 1. Sacrum; 2. Ilium; 3. Ischium; 4. Pubic bone (4a. corpus, 4b. ramus superior, 4c. ramus inferior, 4d. tuberculum pubicum); 5. Pubic symphysis, 6. Acetabulum (of the hip joint), 7. Foramen obturatum, 8. Coccyx/tailbone; Dotted. Linea terminalis of the pelvic brim.
Pelvis anatomy, medial view.
Pelvis anatomy, lateral view.

Clinical Features

  • pelvic/Hip pain
  • Unstable pelvis
  • hypotension if large amounts of bleed
  • Consider concomitant GU injury

Differential Diagnosis

Abdominal Trauma


  • Unstable pelvis on exam
  • Xr pelvis in acute trauma setting
  • CT Pelvis


  • Stabilize fracture with pelvic binder or bed sheet wrapped around greater trochanter (physician's often make mistake of wrapping around the iliac crest)
  • If suspect pelvic injury and patient is unstable, place pelvic binder/sheet immediately then obtain X-ray when patient is stable
    • If patient persistently hypotensive even after binder and suspect pelvic artery bleed consider IR for embolization
  • Long term management requires orthopedic consultation


  • Hypotension from exsanguination
  • infection
  • Loss of function
  • Genitourinary injury



See Also