Pelvic Fracture in Emergency Medicine Treatment & Management
- Author: C Crawford Mechem, MD, MS, FACEP; Chief Editor: Rick Kulkarni, MD more...
Prehospital Care
- Address acute life-threatening conditions. Be very aware that the amount of force necessary to cause a significant pelvic fracture is likely to have caused other significant injuries.
- Application of an external compression device to a grossly unstable pelvis will provide mechanical stabilization while controlling hemorrhage from the fracture site. A sheet or one of a variety of inexpensive, commercial products may be used.[13]
- Avoid excessive movement of the pelvis.
- Obtain large-bore intravenous (IV) access, and administer analgesia and fluids in accordance with local protocols.
- Closely monitor vital signs.
Emergency Department Care
- Treatment involves an algorithmic, multidisciplinary approach.
- Investigate associated intra-abdominal and intrapelvic injuries. A FAST examination should be performed as soon as possible, as well as a chest radiograph to look for other injuries or bleeding sources, especially in the unstable patient.
- Avoid excessive movement of the pelvis.
- If not done by prehospital providers, the pelvis should be rapidly stabilized with a sheet or commercial pelvic external stabilizer.
- This is very important prior to neuromuscular blockade because the muscles may be the only thing maintaining pelvic stability.
- In some patients, such as those with truncal obesity, internal rotation of the lower extremities and taping together the knees may be more effective than a compression binder.[14]
- In the case of unstable pelvic fractures, early application of an external fixation device by the appropriate surgical consultant should be considered.
- Administer fluid replacement and analgesics as needed.
- Do not place a urinary catheter until urethral injury has been ruled out or determined to be unlikely by physical examination or retrograde urethrography.
Consultations
- Consult an orthopedic surgeon when a pelvic fracture is diagnosed. Hemodynamically unstable patients with unstable pelvic fractures require emergent orthopedic consultation for possible external fixation. Pelvic or retroperitoneal packing may be required for hemorrhage control.[15] Intra-aortic balloon occlusion may also have a role to control massive bleeding.[16]
- Consult an interventional radiologist for embolization in the unstable patient.
- Consult a urologist for any suspected urethral injury.
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