Edited by Cameron Egan and Jeffrey “Spud” Olson - 7/1/2021
Descriptors
High energy pelvic injuries are associated with blunt trauma.
Exam Pearls
High energy injuries - (ATLS protocol)
Examine skin closely to rule out open fracture - need to check perineum, do a rectal exam to evaluate for blood
Lower extremity neurovascular exam
Close attention to the L5 nerve root which innervates EHL
Pelvic binder management:
> If pelvic binder is present or needs to be placed then make sure it is placed properly over the greater trochanters
> If patient is hemodynamically unstable then leave binder in place
> If patients is hemodynamically stable then ok to loosen binder for pelvic xray, the binder should be left in position so it can easily be reapplied if patient becomes unstable
Check foley - if unable to place or bloody then there may be a urogenital injury
Workup
Radiographs: AP pelvis, inlet/outlet pelvis xrays
Other imaging: CT Pelvis (usually combined with abdomen/pelvis)
Labs: CBC, lactate, base excess, pre-operative labs
Other: None
Management
Need for acute intervention: If volume expanding injury, immobilization with pelvic binder.
Weight-bearing and range of motion: NWB bilateral lower extremities
Type of immobilization: None
Admission or discharge status: Admit to orthopaedics if isolated injury. Admit to general surgery if poly-trauma
Anticoagulation: Lovenox 40mg
Antibiotics: Open fractures - Ancef, tetanus booster
Surgical Indications
Absolute: Open fracture
Relative: Unstable fracture patterns. Hemodynamic instability for intrapelvic bleeding may be addressed with either pelvic packing or embolization with IR
Not an indication: None