Pelvic Fracture in Emergency Medicine Follow-up

  • Author: C Crawford Mechem, MD, MS, FACEP; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: May 12, 2010
 

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.
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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.
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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.
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Transfer

  • If possible, hemorrhage should be controlled and the pelvis stabilized prior to transfer.
  • Transfer all patients except those with minor pelvic fractures to a trauma center.
  • Complex acetabular fractures may require transfer to a specialist in acetabular fractures.
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Deterrence/Prevention

  • Encourage use of seat belts, airbags, and other protective gear.
  • Promote anti–drunk driving programs and laws.
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Complications

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.[17]
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Prognosis

  • Lower long-term quality of life based on validated questionnaires has been reported in patients with pelvic fractures following high-energy trauma.[18]
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Patient Education

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Contributor Information and Disclosures
Author

C Crawford Mechem, MD, MS, FACEP  Associate Professor, Department of Emergency Medicine, University of Pennsylvania School of Medicine; Emergency Medical Services Medical Director, Philadelphia Fire Department

C Crawford Mechem, MD, MS, FACEP is a member of the following medical societies: American College of Emergency Physicians, National Association of EMS Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Michelle Ervin, MD  Chair, Department of Emergency Medicine, Howard University Hospital

Michelle Ervin, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, National Medical Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

David B Levy, DO, FACEP, FAAEM  Chairman, Department of Emergency Medicine, St Elizabeth Health Center; Associate Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine

David B Levy, DO, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American Medical Informatics Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD 

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

References

  1. Furey AJ, O'Toole RV, Nascone JW, Sciadini MF, Copeland CE, Turen C. Classification of pelvic fractures: analysis of inter- and intraobserver variability using the Young-Burgess and Tile classification systems. Orthopedics. Jun 2009;32(6):401. [Medline].

  2. Sathy AK, Starr AJ, Smith WR, Elliott A, Agudelo J, Reinert CM. The effect of pelvic fracture on mortality after trauma: an analysis of 63,000 trauma patients. J Bone Joint Surg Am. Dec 2009;91(12):2803-10. [Medline].

  3. Ismail N, Bellemare JF, Mollitt DL, et al. Death from pelvic fracture: children are different. J Pediatr Surg. Jan 1996;31(1):82-5. [Medline].

  4. Dechert TA, Duane TM, Frykberg BP, Aboutanos MB, Malhotra AK, Ivatury RR. Elderly patients with pelvic fracture: interventions and outcomes. Am Surg. Apr 2009;75(4):291-5. [Medline].

  5. Kataoka Y, Minehara H, Shimada K, Nishimaki H, Soma K, Maekawa K. Sepsis caused by peripelvic soft tissue infections in critically injured patients with multiple injuries and unstable pelvic fracture. J Trauma. Jun 2009;66(6):1548-54; discussion 1554-5. [Medline].

  6. Giannoudis PV, Grotz MR, Tzioupis C, et al. Prevalence of pelvic fractures, associated injuries, and mortality: the United Kingdom perspective. J Trauma. Oct 2007;63(4):875-83. [Medline].

  7. Balogh Z, King KL, Mackay P, et al. The epidemiology of pelvic ring fractures: a population-based study. J Trauma. Nov 2007;63(5):1066-73; discussion 1072-3. [Medline].

  8. Nabaweesi R, Arnold MA, Chang DC, Rossberg MI, Ziegfeld S, Sawaya DE. Prehospital predictors of risk for pelvic fractures in pediatric trauma patients. Pediatr Surg Int. Sep 2008;24(9):1053-6. [Medline].

  9. Shlamovitz GZ, Mower WR, Bergman J, Chuang KR, Crisp J, Hardy D, et al. How (un)useful is the pelvic ring stability examination in diagnosing mechanically unstable pelvic fractures in blunt trauma patients?. J Trauma. Mar 2009;66(3):815-20. [Medline].

  10. Shlamovitz GZ, Mower WR, Bergman J, et al. Poor test characteristics for the digital rectal examination in trauma patients. Ann Emerg Med. Jul 2007;50(1):25-33, 33.e1. [Medline].

  11. Kirby MW, Spritzer C. Radiographic detection of hip and pelvic fractures in the emergency department. AJR Am J Roentgenol. Apr 2010;194(4):1054-60. [Medline].

  12. Friese RS, Malekzadeh S, Shafi S, et al. Abdominal ultrasound is an unreliable modality for the detection of hemoperitoneum in patients with pelvic fracture. J Trauma. Jul 2007;63(1):97-102. [Medline].

  13. DeAngelis NA, Wixted JJ, Drew J, Eskander MS, Eskander JP, French BG. Use of the trauma pelvic orthotic device (T-POD) for provisional stabilisation of anterior-posterior compression type pelvic fractures: a cadaveric study. Injury. Aug 2008;39(8):903-6. [Medline].

  14. Gardner MJ, Parada S, Chip Routt ML Jr. Internal rotation and taping of the lower extremities for closed pelvic reduction. J Orthop Trauma. May-Jun 2009;23(5):361-4. [Medline].

  15. Hak DJ, Smith WR, Suzuki T. Management of hemorrhage in life-threatening pelvic fracture. J Am Acad Orthop Surg. Jul 2009;17(7):447-57. [Medline].

  16. Martinelli T, Thony F, Declety P, Sengel C, Broux C, Tonetti J, et al. Intra-Aortic Balloon Occlusion to Salvage Patients With Life-Threatening Hemorrhagic Shocks From Pelvic Fractures. J Trauma. Feb 18 2010;[Medline].

  17. Sen RK, Veerappa LA. Outcome analysis of pelvic ring fractures. Indian J Orthop. Jan 2010;44(1):79-83. [Medline].

  18. Borg T, Berg P, Fugl-Meyer K, Larsson S. Health-related quality of life and life satisfaction in patients following surgically treated pelvic ring fractures. A prospective observational study with two years follow-up. Injury. Apr 2010;41(4):400-4. [Medline].

  19. Biffl WL, Smith WR, Moore EE, et al. Evolution of a multidisciplinary clinical pathway for the management of unstable patients with pelvic fractures. Ann Surg. Jun 2001;233(6):843-50. [Medline].

  20. Burgess AR, Eastridge BJ, Young JW, et al. Pelvic ring disruptions: effective classification system and treatment protocols. J Trauma. Jul 1990;30(7):848-56. [Medline].

  21. Grimm MR, Vrahas MS, Thomas KA. Pressure-volume characteristics of the intact and disrupted pelvic retroperitoneum. J Trauma. Mar 1998;44(3):454-9. [Medline].

  22. Hart RG, Rittenberry TJ, Uehara DT. Handbook of Orthopaedic Emergencies. Lippincott-Raven; 1999:277-297.

  23. Holden CP, Holman J, Herman MJ. Pediatric pelvic fractures. J Am Acad Orthop Surg. Mar 2007;15(3):172-7. [Medline].

  24. Knudson MM, Ikossi DG, Khaw L, et al. Thromboembolism after trauma: an analysis of 1602 episodes from the American College of Surgeons National Trauma Data Bank. Ann Surg. Sep 2004;240(3):490-6; discussion 496-8. [Medline].

  25. Koraitim MM. Pelvic fracture urethral injuries: the unresolved controversy. J Urol. May 1999;161(5):1433-41. [Medline].

  26. Lunsjo K, Tadros A, Hauggaard A, et al. Associated injuries and not fracture instability predict mortality in pelvic fractures: a prospective study of 100 patients. J Trauma. Mar 2007;62(3):687-91. [Medline].

  27. Meyhoff CS, Thomsen CH, Rasmussen LS, et al. High incidence of chronic pain following surgery for pelvic fracture. Clin J Pain. Feb 2006;22(2):167-72. [Medline].

  28. Rice PL Jr, Rudolph M. Pelvic fractures. Emerg Med Clin North Am. Aug 2007;25(3):795-802, x. [Medline].

  29. Smith JM. Pelvic fractures. West J Med. Feb 1998;168(2):124-5. [Medline].

  30. Tile M. Acute Pelvic Fractures: I. Causation and Classification. J Am Acad Orthop Surg. May 1996;4(3):143-151. [Medline].

  31. Wiss DA. What's new in orthopaedic trauma. J Bone Joint Surg Am. Nov 2001;83-A(11):1762-72. [Medline].

 
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Anterior-posterior (AP) compression pelvic fracture.
Vertical shear (VS) fracture pattern.
Anteroposterior (AP) compression injury as seen on an AP radiograph of the pelvis. Characteristic features of an AP compression injury include symphyseal and sacroiliac joint diastasis. In this patient, the pubic symphysis and right sacroiliac joint are widened.
Windswept pelvis (lateral compression injury) as seen on a pelvic CT scan. The patient sustained a left lateral compression injury with internal rotation of the left hemipelvis and a characteristic sacral buckle fracture. Note the concomitant left sacroiliac joint diastasis. The lateral force vector continued across the pelvis to produce external rotation of the right hemipelvis and diastasis of the right sacroiliac joint. The combination of injuries resulted in a windswept pelvis.
 
 
 
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