Edited by Cameron Egan and Jeffrey “Spud” Olson - 7/1/2021
Descriptors
Anterior column fractures - anterior ilium, anterior wall of the acetabulum, iliopectineal eminence, superior pubic rami
Posterior column fractures - quadrilateral surface, posterior wall, ischial tuberosity, greater/lesser sciatic notches
Exam Pearls
High energy injuries - see ATLS protocol
Associated lower extremity injury and systemic injuries are common
Thorough lower extremity neurovascular exam in ED
Workup
Radiographs: AP pelvis, Judet views
> Spur sign - seen on obturator oblique - associated both column fracture
> Gull sign - seen on iliac oblique - posterior wall fracture
Other imaging: CT pelvis
Labs: Pre-operative labs
Other: None
Management
Need for acute intervention: Yes, immobilization without reduction. Skeletal traction is indicated in fractures with intra-articular loose bodies, irreducible fracture-dislocations
Weight-bearing and range of motion: Non-weight bearing if unstable fracture pattern.
Type of immobilization: Skeletal traction if indicated
Admission or discharge status: If isolated injury - Admit to ortho. If poly-trauma - generally admit to general surgery service
Anticoagulation: Lovenox 40mg daily
Antibiotics: Open fracture prophylaxis if open fracture
Surgical Indications
Absolute: Displacement of weight-bearing surface without secondary congruence, intra-articular loose bodies, irreducible fracture-dislocation, displacement with exam under anesthesia
Relative: Fracture displacement
Not an indication: Minimal displacement, secondary congruence