Type B:-

http://www.patient.co.uk/doctor/pelvic-fractures

 Rotationally unstable but vertically stable.
B1: 'open book' anteroposterior compression fractures, causing separation of the pubic symphysis and widening of one or both sacroiliac joints.
B2: ipsilateral compression causing the pubic bones to fracture and override.
B3: contralateral compression injury resulting in pubic rami fractures on one side and compression sacroiliac injury on the other side.

Tile classification of pelvic Injuries.

http://www.patient.co.uk/doctor/pelvic-fractures

Type A:

• Stable injuries: include avulsion fractures, isolated pubic ramus fractures, iliac wing fractures or single stable fractures elsewhere in the pelvic ring.
• Avulsion fractures occur at the point of attachment of muscles:
• Anterior inferior iliac spine: rectus femoris; often resulting from a mis-kick into the ground.
• Anterior superior iliac spine: sartorius.
• Ischial tuberosity: hamstrings.

Other signs of pelvic fracture include:-

http://www.patient.co.uk/doctor/pelvic-fractures

Other signs of pelvic fracture include:Haematuria.Rectal bleeding.Large haematoma or palpable fracture line felt on rectal examination.Haematoma above the inguinal ligament, or over the proximal thigh or perineum.Retroperitoneal bleeding, which leads to loin bruising.Neurological and vascular abnormalities in either or both legs.

Rectal examination:-

http://www.patient.co.uk/doctor/pelvic-fractures

• Rectal examination: for anal tone, palpable fractures and to detect bleeding, rectal tears and urethral damage. Signs of urethral injury in males include a high-riding or boggy prostate on rectal examination, scrotal haematoma, or blood at the urethral meatus.
• Instability on hip adduction and pain on hip motion suggests an additional fracture of the acetabulum.
• A pelvic fracture in females is suggested by vaginal bleeding or a palpable fracture line on bimanual examination.

History of significant blunt trauma.

http://www.patient.co.uk/doctor/pelvic-fractures

• Any history of significant blunt trauma should raise the consideration of a pelvic fracture.
• Tenderness, bruising, swelling and crepitus of pubis, iliac bones, hips and sacrum.
• Attempts to 'spring the pelvis' to assess stability should be avoided as this is unreliable and may cause additional haemorrhage or injury.

The most significant fractures.

http://www.patient.co.uk/doctor/pelvic-fractures

However, the most significant fractures involve significant forces such as a car crash or fall from a significant height.

Epidemiology of Pelvic Fractures.

http://www.patient.co.uk/doctor/pelvic-fractures

• In elderly persons, the most common cause is a fall from a standing position. Isolated pubic ramus fractures are common and often missed in the elderly.