Pelvic Fracture in Emergency Medicine Guidelines

Updated: Oct 10, 2017
  • Author: Nicholas Moore, MD; Chief Editor: Trevor John Mills, MD, MPH  more...
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Guidelines

Guidelines Summary

Recommendations for diagnosis of pelvic trauma by the World Society of Emergency Surgery includes the following [15] :

  • The time between arrival in the emergency department and definitive bleeding control should be minimized to improve outcomes of patients with hemodynamically unstable pelvic fractures.

  • Serum lactate and base deficit represent sensitive diagnostic markers to estimate the extent of traumatic-hemorrhagic shock and to monitor response to resuscitation.

  • The use of pelvic x-ray and FAST in the emergency department is recommended in hemodynamic and mechanic unstable patients with pelvic trauma and allows to identify the injuries that require an early pelvic stabilization, an early angiography, and a rapid reductive maneuver, as well as laparotomy.

  • Patients with pelvic trauma associated with hemodynamic normality or stability should undergo further diagnostic workup with multiphasic CT scan with intravenous contrast to exclude pelvic hemorrhage.

  • CT scan with 3-dimensional bone reconstructions reduces the tissue damage during invasive procedures, the risk of neurologic disorders after surgical fixation, operative time, and irradiation and the required expertise.

  • Retrograde urethrogram or/and urethrocystogram with contrast CT scan is recommended in the presence of local perineal clinical hematoma and pelvic disruption at pelvic x-ray.

  • Perineal and a rectal digital examination are mandatory in case of high suspicion of rectal injuries.

  • In cases of a positive rectal examination, proctoscopy is recommended.