Pelvic Fracture in Emergency Medicine Treatment & Management

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

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.
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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.
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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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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

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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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