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
Hover for anatomical points
Shear pelvic fracture with femoral neck fracture

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.

Content by Dr Íomhar O' Sullivan 03/03/2004.   Reviewed by Dr ÍOS 03/04/2005, 08/02/2007. Last review Dr ÍOS 19/01/15