Pelvic Fracture - Suspected - Guidelines for Initial Management of the Adult Patient

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  1. Class I and II Patients
    • Class I and II patients admitted to the Emergency Department (ED) with a pelvic fracture must have the following evaluations:
      • A complete neuro-vascular examination of both lower extremities
      • Appropriate radiographic images
      • An Orthopedic Service consult
    • These patients will be admitted to the Acute Care Surgery Trauma/Burn (ACS) Service with the Orthopedic Service following as a consult.  Pelvic fractures, regardless of their anatomical grade, can be a source of major hemorrhage.  The Orthopedic Surgery Service will decide if a pelvic fixator is indicated.  If continued blood transfusions are required, the patient will proceed to angiography for embolization of pelvic vessels.  (See below for the algorithm for the evaluation and treatment of suspected pelvic fractures.)
    • If after evaluation of all their injuries these patients are found to have an isolated pelvic fracture, and do not require blood transfusions, they may be transferred to the Orthopedic Surgery Service.  Upon discharge from the Orthopedic Surgery Service, these patients will be given a follow-up appointment (to occur within two weeks of discharge) in both the Orthopedic Surgery Service and ACS clinic
    • If these patients are found to have other injury in addition to their orthopedic injury, they will remain on the Trauma Burn Service with the Orthopedic Surgery Service following as a consult.  Upon discharge, these patients will receive follow-up appointments (to occur within two weeks of discharge) in the ACS and Orthopedic Surgery clinics
  2. Class III Patients
    • Class III patients admitted to the ED with a suspected pelvic isolated fracture may have the same evaluation as the Class I and II patient
    • Class III patients with an isolated pelvic fracture and no evidence of blood loss may be directly admitted to the Orthopedic Surgery Service.  Upon discharge, these patients will receive follow-up appointments within two weeks to the orthopedic surgery clinic.  If admission is not required, patients will be discharged from the ED with discharge instructions with a follow-up appointment to the Orthopedic Surgery Clinic within one week.

Management of Severe Pelvic Fractures

  1. Follow ATLS Protocol – ABC’s first
  2. Protect the spine and pelvis at all times
  3. Pelvis fracture suspected – immediately splint with sheet or binder
  4. Early pelvis x-ray is essential
  5. Do NOT test pelvis for mechanical stability
  6. Do NOT log-roll patient until pelvis cleared
  7. Do NOT pass urinary catheter until pelvis cleared
  8. “The first clot is the best clot.” Reduce bleeding by:
    1. Careful patient handling
    2. Early pelvis immobilization
    3. Early blood and blood product transfusion, normalize coags, consider TXA if active hemorrhage, thromboelastometry

Recognize injury patterns

Management of the Pelvic Fracture with Hemodynamic Instability

Thai Lan N. Tran, MD, et al. Western Trauma Association Critical Decisions in Trauma:  Management of pelvic fracture with hemodynamic instability—2016 update. J Trauma Acute Care Surg, 2016;81(6).

https://www.westerntrauma.org/western-trauma-association-algorithms/

Special Thanks

Attribution

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  1. Title: Pelvic Fracture - Suspected - Guidelines for Initial Management of the Adult Patient
  2. Author:  Michigan Medicine
  3. Source: The URL where the image is hosted.
  4. License: “CC BY-NC 4.0”

Pelvic Fracture - Suspected - Guidelines for Initial Management of the Adult Patient,  Michigan Medicine, Dept of Surgery,  “CC BY-NC 4.0”

Last reviewed: 09 June 2021