Pelvic injuries
History of
- major trauma producing unstable fractures
- moderate trauma producing stable fractures
Examination may reveal
- swelling or bruising
- blood at the urethral meatus
- tenderness localised to specific areas, (most of the pelvis is palpable)
- painful springing, - unequal leg length, - distended bladder.
Radiology may reveal
Unstable fracture
(ie. pelvic ring is disrupted in two or more places)
- e.g.. fractured pelvic rami and diastasis of sacroiliac joint or fracture of all 4 pubic rami
- Beware damage to underlying viscera
- In case of bladder do not encourage to pass urine or catheter
- Check distal neurovascular
- IVI and X-match 6 units
- Refer ortho and urology if appropriate
Stable injury
(ie. pelvic ring is disrupted in one area)
- fracturesof 1 or 2 pubic rami or other fractures e.g.. wing of ilium, acetabulum
- Assess mobility
- Bedrest and analgesia at home or in hospital according to pain, age and social circumstances
Immediate management
- Get help from your emergency medicine senior
- Check ABCs (assume other significant injuries until excluded) (particularly chest injuries)
- Stabilise pelvis with sling or sheet (try to reduce haemorrrhage)
- At least two large bore IV cannulae with confirmed crossmatch request
- Trauma series
- Treat as major trauma case with trauma team activation where available.
