Pelvic Fracture in Emergency Medicine Follow-up
- Author: C Crawford Mechem, MD, MS, FACEP; Chief Editor: Trevor John Mills, MD, MPH more...
Further Outpatient Care
Elderly patients with isolated pubic rami fractures can be safely discharged if they can be cared for at home or in another facility. They will require sufficient pain management to allow them to ambulate, or they should have sufficient help. If they are nonambulatory, DVT prophylaxis should be considered.
Further Inpatient Care
Monitor patients with pelvic fracture for signs of ongoing blood loss and signs of infection. In addition, patients should be closely observed for development of neurovascular problems in the lower extremities. For example, injury to the sacral nerves, lower lumbar nerves, and sympathetic chain may occur.
Consider deep venous thrombosis (DVT) prophylaxis in all patients. Pelvic fractures give an odds ratio for venous thromboembolic events (VTE) of 2.93.
Pain management is very important to facilitate early mobilization, thereby reducing the risk of thromboembolic disease.
Management of urethral injuries should be directed by a urologic consultation. If a urinary catheter is required prior to the urologist's arrival, a suprapubic catheter should be placed.
Inpatient & Outpatient Medications
Inpatient medications should be determined by the orthopedic specialist or trauma surgeon depending on associated injuries. Pain medications as outlined above will be required (see Medication); other medications depend on associated injuries.
Transfer all patients except those with minor pelvic fractures to a trauma center. Trauma center care is associated with decreased mortality in patients with unstable pelvic fractures or complicated acetabular fractures.
Application of a pelvic circumferential compression device prior to transfer has been shown to decrease the amount of tranfusions required and length of ICU stay at the receiving hospital and is therefore recommended.[29, 30]
If possible, hemorrhage should be controlled and the pelvis stabilized prior to transfer.
Encourage use of seat belts, airbags, and other protective gear.
Promote anti–drunk driving programs and laws.
Complications of pelvic fracture include the following:
- The incidence of deep venous thrombosis is increased.
- Continued bleeding from fracture or injury to pelvic vasculature may occur.
- GU problems from bladder, urethral, prostate, or vaginal injuries: The incidence of urethral injuries varies by the type of pelvic fracture. Straddle fractures associated with sacroiliac diastasis have the highest incidence (odds ratio of 24). Without diastasis, the odds ratio dropped to 3.85. Urethral injuries are uncommon in patients with fractures not involving the ischiopubic rami.
- Sexual dysfunction may develop.
- Infections from disruption of bowel or urinary system may develop.
- Chronic pelvic pain, more so if the sacroiliac joints are involved, may occur.
Lower long-term quality of life based on validated questionnaires has been reported in patients with pelvic fractures following high-energy trauma.[32, 33]
For excellent patient education resources, see eMedicineHealth's patient education article Total Hip Replacement.
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