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