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

(i.e. 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

(i.e. pelvic ring is disrupted in one area)

  • fractures of 1 or 2 pubic rami or other fractures e.g. wing of ilium, acetabulum
  • Assess mobility
  • Bed-rest 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 haemorrhage)
  • At least two large bore IV cannulae with confirmed cross-match request
  • Trauma CT (when safe)
  • Treat as major trauma case with trauma team activation where available

Fat embolism

Please beware pelvic and long bone fractures may triger fat emboli. Classically a triad of:

  • desaturation
  • cutaneous petechiae
  • confusion

May also have "meningism" and ↑↑BP (cerebral hypoperfusion response).

Treatment is supportive.

Content by Dr Íomhar O' Sullivan 03/03/2004.   Reviewed by Dr ÍOS 03/04/2005, 08/02/2007. Last review Dr ÍOS 21/06/21