1. The Pelvis Is Made Up of Three Bones
The three bones in the pelvis are the ilium, the ischium and the pubis. The ilium is the one you can feel when you place your hand on your hips. The part you are resting on is the iliac wing. The ischium is the part of the pelvis that you sit on. If you trace your hamstring muscles up your thigh, you will feel the ischial tuberosity. The pubis is the bone in front. The two pubic bones meet together at the pubic symphysis. Incidentally, this is the joint that widens to allow childbirth.
2. The Pelvis Is a Ring
The pelvis meets the sacrum at the sacroiliac (SI) joints. Together with the sacrum, these bones form a ring, which is held together by some of the strongest ligaments in your body. All of your body weight is transferred down the spine, through the pelvis and down the legs. It also provides protection to some vital internal organs and houses some major blood vessels.
3. High-Energy Injuries
Fractures to the pelvis or disruptions in the pelvic ring are usually high-energy injuries, such as car or motorcycle accidents and falls from heights. Pelvic fractures can also occur as the bones become thinner (osteoporosis). Osteoporotic fracture can occur with ground-level falls, but these are usually pubic rami fractures. The superior and inferior pubic rami are the bones above and below the two big holes that you see on an X-ray. Most of these low-energy injuries can be treated with protected weight-bearing, either with a walker or wheelchair. The ample amount of muscles surrounding the rami stabilize the fractures.
4. They Can Cause a Lot of Bleeding
The higher-energy injuries can cause a great deal of bleeding, to the point where a person may go into shock. Fractures or dislocations of the pelvic bones can lacerate or tear the large blood vessels lying on the pelvic bones. This can cause large amounts of blood to be lost rapidly. These injuries need to be treated by medical personnel immediately. With this type of pelvic injury, there are usually other potentially life-threatening injuries as well, including to the major organs (heart, lungs, abdomen, liver, spleen and others). The pelvis should be stabilized to prevent further bleeding. An angiogram may sometimes be required to cauterize some of the bleeding vessels.
5. Surgery May Be Required
If the pelvic ring is unstable, surgery is usually required. This involves inserting plates and screws to restore the stability of the entire pelvis (otherwise the bones will be at different heights, for example). These pelvic injuries can cause life-changing disabilities.
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