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Pelvic Fracture in Emergency Medicine Follow-up

  • Author: C Crawford Mechem, MD, MS, FACEP; Chief Editor: Trevor John Mills, MD, MPH  more...
Updated: Aug 20, 2015

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.[28]

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.[31]  


Lower long-term quality of life based on validated questionnaires has been reported in patients with pelvic fractures following high-energy trauma.[32, 33]


Patient Education

For excellent patient education resources, see eMedicineHealth's patient education article Total Hip Replacement.

Contributor Information and Disclosures

C Crawford Mechem, MD, MS, FACEP 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, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

David B Levy, DO, FAAEM Senior Consultant in Emergency Medicine, Waikato District Health Board, New Zealand; Associate Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine

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

Disclosure: Nothing to disclose.

Chief Editor

Trevor John Mills, MD, MPH Chief of Emergency Medicine, Veterans Affairs Northern California Health Care System; Professor of Emergency Medicine, Department of Emergency Medicine, University of California, Davis, School of Medicine

Trevor John Mills, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians

Disclosure: Nothing to disclose.


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.

  1. Bailey JR, Stinner DJ, Blackbourne LH, Hsu JR, Mazurek MT. Combat-related pelvis fractures in nonsurvivors. J Trauma. 2011 Jul. 71(1 Suppl):S58-61. [Medline].

  2. 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. 2009 Jun. 32(6):401. [Medline].

  3. Cross AM, Davis C, Penn-Barwell J, Taylor DM, De Mello WF, Matthews JJ. The incidence of pelvic fractures with traumatic lower limb amputation in modern warfare due to improvised explosive devices. J R Nav Med Serv. 2014. 100 (2):152-6. [Medline].

  4. Osterhoff G, Scheyerer MJ, Fritz Y, Bouaicha S, Wanner GA, Simmen HP, et al. Comparing the predictive value of the pelvic ring injury classification systems by Tile and by Young and Burgess. Injury. 2014 Apr. 45 (4):742-7. [Medline].

  5. 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. 2009 Dec. 91(12):2803-10. [Medline].

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

  7. Gänsslen A, Hildebrand F, Pohlemann T. Management of hemodynamic unstable patients "in extremis" with pelvic ring fractures. Acta Chir Orthop Traumatol Cech. 2012. 79(3):193-202. [Medline].

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

  9. 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. 2009 Jun. 66(6):1548-54; discussion 1554-5. [Medline].

  10. Langford JR, Burgess AR, Liporace FA, Haidukewych GJ. Pelvic fractures: part 2. Contemporary indications and techniques for definitive surgical management. J Am Acad Orthop Surg. 2013 Aug. 21 (8):458-68. [Medline].

  11. Burkhardt M, Kristen A, Culemann U, Koehler D, Histing T, Holstein JH, et al. Pelvic fracture in multiple trauma: are we still up-to-date with massive fluid resuscitation?. Injury. 2014 Oct. 45 Suppl 3:S70-5. [Medline].

  12. Godzik J, McAndrew CM, Morshed S, Kandemir U, Kelly MP. Multiple lower-extremity and pelvic fractures increase pulmonary embolus risk. Orthopedics. 2014 Jun. 37 (6):e517-24. [Medline].

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

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

  15. 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. 2008 Sep. 24(9):1053-6. [Medline].

  16. 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. 2009 Mar. 66(3):815-20. [Medline].

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

  18. Johnson MH, Chang A, Brandes SB. The value of digital rectal examination in assessing for pelvic fracture-associated urethral injury: what defines a high-riding or nonpalpable prostate?. J Trauma Acute Care Surg. 2013 Nov. 75 (5):913-5. [Medline].

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

  20. 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. 2007 Jul. 63(1):97-102. [Medline].

  21. 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. 2008 Aug. 39(8):903-6. [Medline].

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

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

  24. 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. 2010 Feb 18. [Medline].

  25. Siebler J, Dipasquale T, Sagi HC. Use of temporary partial intrailiac balloon occlusion for decreasing blood loss during open reduction and internal fixation of acetabular and pelvis fractures. J Orthop Trauma. 2012 Jun. 26(6):e54-7. [Medline].

  26. Niola R, Pinto A, Sparano A, Ignarra R, Romano L, Maglione F. Arterial bleeding in pelvic trauma: priorities in angiographic embolization. Curr Probl Diagn Radiol. 2012 May-Jun. 41(3):93-101. [Medline].

  27. Roudsari BS, Psoter KJ, Padia SA, Kogut MJ, Kwan SW. Utilization of angiography and embolization for abdominopelvic trauma: 14 years' experience at a level I trauma center. AJR Am J Roentgenol. 2014 Jun. 202 (6):W580-5. [Medline].

  28. Morshed S, Knops S, Jurkovich GJ, Wang J, MacKenzie E, Rivara FP. The impact of trauma-center care on mortality and function following pelvic ring and acetabular injuries. J Bone Joint Surg Am. 2015 Feb 18. 97 (4):265-72. [Medline].

  29. 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. 2004 Sep. 240(3):490-6; discussion 496-8. [Medline].

  30. Fu CY, Wu YT, Liao CH, Kang SC, Wang SY, Hsu YP, et al. Pelvic circumferential compression devices benefit patients with pelvic fractures who need transfers. Am J Emerg Med. 2013 Oct. 31 (10):1432-6. [Medline].

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

  32. 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. 2010 Apr. 41(4):400-4. [Medline].

  33. 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. 2007 Mar. 62(3):687-91. [Medline].

  34. 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. 2001 Jun. 233(6):843-50. [Medline].

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

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

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

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

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

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

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

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

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

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

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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