Pelvic Fracture

[Pelvic Fx By Anatomy]

CLINICAL

DX

TREATMENT

  1. Due to associated hemorrhage & other injuries, pts with pelvic fractures may need resuscitation with crystalloid, blood, & blood products.
  2. Stabilize the pelvis with a bed sheet or other pelvic binding device to stabilize fracture ends.
  3. In hemodynamically unstable pt, evaluate for other locations of bleeding such as the thorax & the peritoneal cavity using a chest XR & FAST examination.
  4. After excluding other sources of hemorrhage, treatment for ongoing hemodynamic instability in pt with pelvic fracture includes angiography with embolization & external fixation.
  5. With the exception of lateral compression type I & AP compression type I injuries, all other pelvic ring fractures require ORIF
  6. Acetabular fracturesOrtho consult and hospital admission.
  7. The treatment & disposition of single bone fractures are listed in table below.
  • Type I
    • Avulsion and single bone fracture
    • Result of direct trauma or forceful muscle contraction
    • Tx: conservative management
  • Type II
    • Single ring fracture
    • Tx: Conservative management
  • Type III
    • Double ring fracture
    • unstable injuries with associated intrapelvic injuries
    • life-threatening hemorrhage more common with posterior fractures
    • Management:
      • Immobilize
      • Resuscitation
      • Ortho consult for external or internal fixation
      • Embolization for hemorrhage
  • Type IV
    • Acetabulum fracture
    • Due to high energy forces (MVA)
    • Tx: Displaced fracture requires surgical repair


Avulsion and Single Bone Fractures:
Fracture Description/
Mechanism of Injury
Clinical Findings/
Associated Injuries
Treatment Disposition and Follow-Up
Iliac wing (Duverney) fracture Direct trauma, usually lateral to medial Swelling, tenderness over iliac wing; abdominal pain; ileus; acetabular fractures; serious injury infrequent Analgesics, non-weightbearing until hip abductors pain-free, usually nonoperative Discharge with orthopedic follow-up in 1-2 wk; admit for open fracture or concerning abdominal examination
Single ramus of pubis or ischium Fall or direct trauma in elderly; exercise-induced stress fracture in young or in pregnant women Local pain and tenderness; may have inability to ambulate Analgesics, crutches Discharge with PCP or orthopedic follow-up in 1-2 wk
Ischium body External trauma or from fall in sitting position; least common pelvic fracture Local pain and tenderness; pain with hamstring movement Analgesics, bed rest, donut-ring cushion, crutches Discharge with orthopedic follow-up in 1-2 wk
Sacral fracture Transverse fractures from direct anteroposterior trauma; upper transverse fractures from fall in flexed position Pain on rectal examination; sacral root injury with upper transverse fractures; vertical fractures may transect the pelvic ring Analgesics, bed rest, surgery may be needed for displaced fractures or neurologic injury Discharge with orthopedic follow-up 1-2 wk; orthopedic consultation for displaced fractures or neurologic deficits
Coccyx fracture Fall in sitting position; more common in women Pain, tenderness over sacral region; pain on compression during rectal examination Analgesics, bed rest, stool softeners, sitz baths, donut-ring cushion PCP or orthopedic follow-up in 2-3 wk; surgical excision of fracture fragment if chronic pain
Anterior superior iliac spine Forceful sartorius muscle contraction (e.g., adolescent sprinters) Pain with hip flexion and abduction Analgesics, bed rest for 3-4 wk with hip flexed and abducted, crutches Discharge with orthopedic follow-up in 1-2 wk
Anterior inferior iliac spine Forceful rectus femoris muscle contraction (e.g., adolescent soccer players) Pain in groin; pain with hip flexion Analgesics, bed rest for 3-4 wk with hip flexed, crutches Discharge with orthopedic follow-up in 1-2 wk
Ischial tuberosity Forceful contraction of hamstrings Pain with sitting or flexing the thigh Analgesics, bed rest for 3-4 wk in extension, external rotation, crutches Discharge with orthopedic follow-up in 1-2 wk





Open Book Pelivc Fracture: