Question 1

My father was in a car accident and has an open book pelvic fracture—the doctors say he's 'hemodynamically unstable' and needs emergency surgery. What does this mean and what are his chances of survival?

Accepted Answer

'Hemodynamically unstable' means your father's blood pressure is dangerously low due to massive bleeding from the pelvic fracture, and his heart is working overtime trying to compensate (rapid heart rate). This is a life-threatening medical emergency. Here's what's happening and realistic expectations: WHY OPEN BOOK FRACTURES BLEED: When pelvis opens like a book, it disrupts massive venous plexus (network of veins) in pelvis and sometimes tears major arteries (internal iliac arteries). Pelvis also contains spongy bone that bleeds. Blood collects in retroperitoneal space (space behind abdominal organs) where it can't be easily compressed. Patients can lose liters of blood very quickly (normal adult has 5 liters total blood volume—can lose 2-3 liters into pelvis in minutes). WHAT 'EMERGENCY SURGERY' INVOLVES: Goal is hemorrhage control, not definitive fracture fixation yet. Options: Pelvic binder to close pelvis (already done), External fixator (pins and bars to hold pelvis closed), Pelvic packing (opening abdomen and stuffing pelvis with surgical sponges to stop bleeding), Angiography/embolization (blocking bleeding arteries with coils). Simultaneously: massive transfusion protocol activated (rapidly infusing blood products—red cells, plasma, platelets in balanced ratios to replace lost blood and restore clotting). SURVIVAL EXPECTATIONS: Depends on: Blood loss volume (if less than 4-6 units transfused, better prognosis; if 10-20+ units, much worse), Associated injuries (head injury, chest trauma, abdominal bleeding worsen prognosis), Time to treatment (faster bleeding control better—delays increase mortality), Age and pre-existing health (older patients, those with heart disease have worse outcomes). MORTALITY RATES: Overall for open book fractures: 10-20% mortality (1 in 5 to 1 in 10 don't survive). Hemodynamically stable patients (blood pressure controlled with minimal transfusion): 5% mortality. Hemodynamically unstable patients (like your father—requiring emergency surgery, massive transfusion): 20-30% mortality. Patients arriving in hemorrhagic shock with cardiac arrest: 50-80% mortality. CRITICAL PERIOD: Next 24-48 hours are most dangerous. If your father survives emergency surgery and bleeding controlled, survival chances improve dramatically. IF HE SURVIVES: Will likely spend days-weeks in ICU recovering from blood loss, treating associated injuries. Once stabilized, will need definitive pelvic fixation surgery. Long recovery (6-12 months), but 60-70% of survivors achieve reasonable functional recovery. WHAT YOU CAN DO: Be present for family, prepare for difficult conversations with trauma team, consider: Does your father have advance directive or medical power of attorney? Who makes medical decisions if he can't? Trauma teams will do everything possible to save him, but open book fractures with hemodynamic instability are among the most serious survivable injuries.

Question 2

I survived an open book pelvic fracture 6 months ago and have ongoing pelvic pain and problems with sexual function. The surgeons say the fracture 'healed well' on X-rays—why do I still have these problems?

Accepted Answer

You're experiencing very common long-term complications of open book pelvic fractures that affect 30-50% of survivors even when fracture healing looks good on X-rays. Pelvic ring injuries cause problems beyond the broken bones. Here's why: PELVIC PAIN CAUSES: Even with 'healed' fracture, pain may come from: SI joint arthritis (20-30% of patients develop this)—sacred injury or SI disruption damages joint cartilage, leading to degenerative changes causing chronic pain. Residual pelvic asymmetry (even 5-10mm differences invisible on X-ray cause altered biomechanics and chronic pain). Soft tissue injuries (muscles, ligaments torn during injury never fully recover normal function). Nerve injuries (see below). Post-traumatic arthritis in hip joints (if acetabulum involved or altered pelvic mechanics overload hips). SEXUAL DYSFUNCTION: Extremely common after pelvic fractures (20-30% of patients) due to: Nerve injuries—lumbosacral plexus or pudendal nerves damaged during initial injury (can cause erectile dysfunction in men, reduced sensation in men/women). Vascular injuries—internal pudendal artery damage reducing blood flow (erectile dysfunction). Psychological trauma—PTSD from accident, body image issues, pain during intercourse. Urethral injuries (if you had urethral tear)—scarring causes ongoing issues. Pelvic floor muscle dysfunction—muscles/ligaments supporting pelvic organs injured, causing pain or dysfunction. WHAT CAN BE DONE: For pelvic pain: Physiotherapy focusing on pelvic stabilization, core strengthening, hip mobility. Pain management (NSAIDs, neuropathic pain medications like gabapentin if nerve pain). SI joint injections (steroid injections into SI joint if that's pain source—provides temporary relief, some patients get radiofrequency ablation for longer relief). Pelvic brace or support garments. Revision surgery rarely helps unless clear mechanical problem (hardware failure, nonunion). For sexual dysfunction: Urologist consultation (specialized pelvic trauma urologists assess nerve/vascular function). Medications (sildenafil/Viagra for erectile dysfunction if vascular cause). Penile rehabilitation program if nerve injury. Pelvic floor physiotherapy (specialized physios treat pelvic floor muscle dysfunction). Sex therapy/counseling (address psychological components). REALISTIC EXPECTATIONS: Many patients see gradual improvement over 12-24 months post-injury as nerves recover (slowly—1mm per day), soft tissues remodel, and they adapt. However, 20-30% have permanent chronic issues requiring ongoing management. SUPPORT RESOURCES: Trauma support groups, pelvic pain clinics (many major hospitals have multidisciplinary pelvic pain teams—pain specialists, physios, psychologists). Sexual medicine specialists. Your pain and dysfunction are REAL, common, and not 'in your head' even though X-rays look good. Healed bones don't equal healed patient. Keep advocating for comprehensive care addressing all these issues.

Medical Disclaimer

Severe Pelvic Ring Injury (Open Book Pelvic Fracture)

📖What is Severe Pelvic Ring Injury (Open Book Pelvic Fracture)?

🔬What Causes It?

⚠️Risk Factors

You may be at higher risk if:

🛡️Prevention