Edited by Cameron Egan and Jeffrey “Spud” Olson - 7/1/2021
Descriptors
Considered stable injuries Oblique or transverse ramuse fracture with ipsilateral (normally) anterior sacral ala compression fracture (Lateral compression type 1) - most common* Symphysis widening <2.5cm (Anterior posterior compression type 1)
Exam Pearls
Lower extremity neurovascular exam
Gentle rotational force on each iliac crest - low sensitivity for instability
Workup
Radiographs: AP pelvis
Other imaging: CT pelvis (consider CT angio if concern for vascular injury)
Labs: Not usually indicated unless hemodynamically unstable
Other: None
Management
Need for acute intervention: None usually indicated. Stable injury pattern.
Weight-bearing and range of motion: WBAT and ROMAT - normally with bilateral upper extremity support
Type of immobilization: None
Admission or discharge status: Admit to ED observation for PT evaluation
Anticoagulation: Consider Lovenox 40mg daily x28 days
Antibiotics: None
Surgical Indications
Absolute: None
Relative: Very few indications. Some consider fixing very displaced rami fractures in women of childbearing age.
Not an indication: Pain