The ischium, ilium, and pubis are connected by strong ligamentous attachments to the sacrum and coccyx to form the anatomical bony pelvis. Pelvic ring disruptions (open-book fractures), in which the anterior and posterior pelvis are disrupted in 2 or more places, comprise the most serious pelvic injuries and account for most of the clinically significant hemorrhages seen in trauma involving the pelvis.
A dense and extensive network of vessels, including the common iliac arteries and veins, bifurcate at the beginning of the pelvic brim and run through the posterior-lying retroperitoneum. The internal iliac vein forms from the venous plexus system running over the sacrum so that injuries to the pelvic floor and ring can intrude on this dense vasculature and precipitate significant hemorrhage. (See Figure 1.)
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