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Sections Pelvic Fracture in Emergency Medicine
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Medication

Medication Summary

The primary treatment of pelvic fracture is for pain with narcotic analgesics. Avoid nonsteroidal anti-inflammatory drugs until hemorrhage has been excluded, as it is the most common cause of mortality in pelvic fractures.

If open pelvic fracture is diagnosed or suspected, empiric antibiotics should be given within 6 hours to prevent osteomyelitis. Initial therapy should target gram-positive organisms with antibiotics such as cefazolin.^[16]

If there is concern for associated perforation of bowel or vagina, broad-spectrum antibiotic coverage against gram-negative and anaerobic pathogens should be considered.

Patients with open pelvic fractures should also receive prophylaxis against tetanus.

Class Summary

Narcotic analgesics are the treatment of choice in the acute setting. Pain control is essential to quality patient care. It ensures patient comfort, promotes pulmonary toilet, and aids physical therapy regimens. Many analgesics have sedating properties that benefit patients who have sustained fractures. Adequate pain control helps keep the patient quiet and avoids movement of the pelvis.

Morphine sulfate (Duramorph, Astramorph, MS Contin)

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DOC for narcotic analgesia because of its reliable and predictable effects, safety, and ease of reversibility with naloxone. Administered IV, may be dosed in a number of ways and commonly is titrated until desired effect obtained. Titrated doses especially useful in trauma patients to avoid oversedation or hypotension. Caution in hypotensive patients as may worsen hypotension because of histamine release. Consider fentanyl in this setting.

Fentanyl (Sublimaze, Duragesic)

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Excellent drug for analgesia in patients with hypotension or whose cardiovascular condition is unstable. Does not release histamine. Short-acting acutely, duration becomes longer with repetitive dosing.

Acetaminophen (Tylenol, Panadol, aspirin-free Anacin)

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DOC for treatment of pain in patients with documented hypersensitivity to aspirin or NSAIDs or those at high risk of bleeding, with upper GI disease, or taking oral anticoagulants. DOC for pain relief in noninflammatory conditions.

Hydrocodone bitartrate and acetaminophen (Vicodin ES)

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Drug combination indicated for relief of moderately severe to severe pain.

Oxycodone and acetaminophen (Percocet, Tylox, Roxicet, Roxilox)

View full drug information

Drug combination indicated for relief of moderately severe to severe pain. DOC for aspirin-hypersensitive patients.

Oxycodone and aspirin (Percodan, Roxiprin)

View full drug information

Drug combination indicated for relief of moderately severe to severe pain. Avoid in early treatment because of platelet inhibition from aspirin and increased risk of bleeding. See discussion under NSAIDs above.

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Media Gallery

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.
Pelvic apophyseal avulsion fracture of the ischial tuberosity due to contraction of the hamstring muscles. Courtesy of Wikipedia (https://de.wikipedia.org/wiki/Apophyse).

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Tile Classification System ^[17]

Type A	Sacroiliac complex is intact. Stable fractures of the pelvic ring that can be managed nonoperatively.
Type B	Rotationally unstable, vertically stable. Caused by external or internal rotation forces causing partial disruption of the posterior sacroiliac complex.
Type C	Rotationally and vertically unstable. Complete disruption of the posterior sacroiliac complex.

Young and Burgess Classification System ^[18]

Lateral Compression
Grade I	Sacral compression fracture on side of impact.
Grade II	Sacral compression fracture with associated posterior iliac fracture on side of impact.
Grade III	Type I or II plus associated contralateral sacroiliac joint injury.
Anterior-Posterior Compression
Grade I	Mild widening of the pubic symphysis with intact posterior pelvic ring ligaments and sacroiliac ligaments.
Grade II	Diastasis of pubic symphysis with associated anterior sacroiliac joint widening with intact posterior sacroiliac joint ligaments.
Grade III	Diastasis of pubic symphysis with complete disruption of sacroiliac joint and posterior pelvic ring ligaments.
Vertical Shear	Displacement of the hemipelvis superiorly or posteriorly involving diastasis of the pubic symphysis, rami fractures, displacement of the sacroiliac joint, and/or fractures of the iliac wing or sacrum.
Combined Mechanism	Because of the high-energy nature of these injuries, the mechanisms are often combined and difficult to determine and categorize.

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Author

Nicholas Moore, MD Resident Physician, Department of Emergency Medicine, University of Kentucky-Chandler Medical Center

Nicholas Moore, MD is a member of the following medical societies: American Academy of Emergency Medicine, American Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Christopher I Doty, MD, MAAEM, FACEP Tenured Professor of Emergency Medicine, University of Kentucky College of Medicine; Vice Chair of Education, Department of Emergency Medicine, University of Kentucky Chandler Medical Center

Christopher I Doty, MD, MAAEM, FACEP is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, Council of Emergency Medicine Residency Directors

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.

Additional Contributors

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.

Acknowledgements

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.

Sections Pelvic Fracture in Emergency Medicine
Overview
Presentation
- History
- Physical
- Causes
- Complications
- Show All
DDx
Workup
Treatment
Guidelines
Medication
Media Gallery
Tables
References

Pelvic Fracture in Emergency Medicine Medication

Medication Summary

Analgesics

Class Summary

Morphine sulfate (Duramorph, Astramorph, MS Contin)

Morphine sulfate (Duramorph, Astramorph, MS Contin)

Fentanyl (Sublimaze, Duragesic)

Fentanyl (Sublimaze, Duragesic)

Acetaminophen (Tylenol, Panadol, aspirin-free Anacin)

Acetaminophen (Tylenol, Panadol, aspirin-free Anacin)

Hydrocodone bitartrate and acetaminophen (Vicodin ES)

Hydrocodone bitartrate and acetaminophen (Vicodin ES)

Oxycodone and acetaminophen (Percocet, Tylox, Roxicet, Roxilox)

Oxycodone and acetaminophen (Percocet, Tylox, Roxicet, Roxilox)

Oxycodone and aspirin (Percodan, Roxiprin)

Oxycodone and aspirin (Percodan, Roxiprin)

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Pelvic Fracture in Emergency Medicine Medication

Medication Summary

Analgesics

Class Summary

Morphine sulfate (Duramorph, Astramorph, MS Contin)

Morphine sulfate (Duramorph, Astramorph, MS Contin)

Fentanyl (Sublimaze, Duragesic)

Fentanyl (Sublimaze, Duragesic)

Acetaminophen (Tylenol, Panadol, aspirin-free Anacin)

Acetaminophen (Tylenol, Panadol, aspirin-free Anacin)

Hydrocodone bitartrate and acetaminophen (Vicodin ES)

Hydrocodone bitartrate and acetaminophen (Vicodin ES)

Oxycodone and acetaminophen (Percocet, Tylox, Roxicet, Roxilox)

Oxycodone and acetaminophen (Percocet, Tylox, Roxicet, Roxilox)

Oxycodone and aspirin (Percodan, Roxiprin)

Oxycodone and aspirin (Percodan, Roxiprin)

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Tables

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