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Updated: Dec 28 2021

Pelvic Fracture

  • Snapshot
    • A 23-year-old man presents to the emergency department after a motor vehicle accident. He was riding in the front seat of the car while wearing a seatbelt. After the accident, he developed severe pain in the pelvic region. The emergency medical technician arrived at the scene and immediately immobilized the patient and intravenous fluids are started. The patient’s blood pressure is 98/62 mmHg and pulse is 104/min. In the emergency department, there is disfigurement of the hip with ecchymosis in the affected area. There is no blood in the urethral meatus. A radiograph of the pelvis demonstrates a pelvic fracture. A pelvic binder is placed and orthopedic surgery is consulted.
  • Introduction
    • Clinical definition
      • fracture of the pelvic bone
  • Epidemiology
    • Incidence
      • highest in patients 15-28 years of age
      • < 35 years of age
        • more common in men
      • > 35 years of age
        • more common in women
  • Etiology
    • Low-energy trauma
      • e.g., fall and athletic injury
    • High-energy trauma
      • e.g., motor vehicle accident
    • Pathogenesis
      • trauma to the pelvis may result in fracture
        • hemorrhage may occur with the pelvic fracture due to bleeding from
          • the exposed fracture
          • injury to soft tissues
          • venous bleeding
  • Presentation
    • Symptoms
      • pain
      • disability
    • Physical exam
      • physical exam findings depend on the severity of the trauma and involved structures
      • pelvic deformity
      • hematomas may be present
      • the patient may have associated injuries involving the
        • head
        • chest
        • abdomen
  • Imaging
    • Radiography
      • indication
        • initial imaging study in patients with suspected pelvic trauma
      • view
        • anteroposterior view of the pelvis
    • Computerized tomography (CT) scan
      • indication
        • gold standard imaging modality for pelvic fracture
  • Studies
    • Labs
      • in the emergency setting, the following labs are typically ordered
        • complete blood count
        • hemoglobin and hematocrit
          • to monitor for ongoing blood loss
        • blood type and screen
          • in case a blood transfusion is needed
        • creatinine and urine studies
        • coagulation profile
        • toxicology screen
    • Making the diagnosis
      • a clinical diagnosis supported by imaging studies
  • Treatment
    • Conservative
      • pelvic binder
        • indication
          • to create a tamponade effect, stabilize the fracture, and improve patient comfort
    • Operative
      • vessel embolization
        • indication
          • can be indicated in cases of refractory bleeding
  • Complications
    • Neurological injury
      • erectile dysfunction due to nerve damage
    • Infection
    • Hemorrhage
  • Prognosis
    • Improved outcomes in patients managed with early pelvic stabilization
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