I read recently in the Guardian with great interest that Angela Merkel had been diagnosed with a pelvic fracture. The story read along the lines that she had a fall whilst skiing and having struggled to walk around for a few days with severe bruising down her thighs realised something wasn’t right. She subsequently booked in for a specialist review and a fracture of her deep pelvic bones was found.
This triggered off a memory from earlier in my career whilst working in private clinics in and around London. Your natural assumption would be that this type of injury is rare and probably only limited to those doing extreme sports. Well one of these assumptions is correct they are relatively rare injuries, however all of the incidences of the injury I diagnosed were found in cyclists that had been knocked off or fallen from their bikes and impacted onto their sides.
The characteristics of the injuries were the same:
- A fall from a bike onto hard concrete impacting onto the greater trochanter
- Immediate pain and discomfort, but when first x-rayed no fractures were found
- Within one week the patient noticed severe bruising down into the thighs
- Difficulty walking for up to 12 weeks
- The fracture was on the contralateral side to impact and was diagnosed by MRI, this was found to be the superior pelvic rami
- Deep seated pain on adductor squeeze testing (straight leg)
The pelvic ring is a seriously strong structure it takes serious force to disrupt it, in most of the literature you’ll find that the pelvic rami are often injured in car crashes or falls from a great height. If you think about falls from a bike at speed, the forces involved could be similar to those of falls from a great height.
These injuries were often stable fractures, meaning the bones were not displaced and intervention from a surgical perspective was not required. We managed each case with relative rest and gradual build up of leg and core strength. Bear in mind that it took these cases up to 6 months before they were pain free.
So if you are an active person and have had a fall onto your side with some force, still struggling to walk after 6 weeks, have bruising down both thighs and a deep seated pain between your legs. Maybe go and say hello to your local health professional.