Signs and symptoms of pelvic injuries vary from local pain and tenderness to pelvic instability and severe shock. Examine the patient for pain, pelvic instability, deformities, lacerations, ecchymoses, and hematomas. Avoid excessive movement of unstable fractures as this could produce further injury and cause additional blood loss. Rectal examination may reveal displacement of the prostate or rectal injury. Blood at the urethral meatus suggests urethral injury. A vaginal speculum examination may be indicated to detect lacerations that would suggest an open fracture. If a pelvic fracture is found, assume associated intraabdominal, retroperitoneal, gynecologic, or urologic injuries exist until proven otherwise.
Diagnosis and Differential
In patients with a suspected pelvic fracture, obtain a standard anteroposterior (AP) pelvis radiograph to evaluate for bony injury. Other radiographic views include lateral views, AP views of the hemipelvis, internal and external oblique views of the hemipelvis, or inlet and outlet views of the pelvis. CT is superior to pelvic radiographs for identifying pelvic fractures and evaluating pelvic ring instability. Therefore, consider CT if there is a high suspicion for fracture but negative pelvic radiographs. In an unstable blunt trauma patient, use an AP pelvic radiograph to identify a pelvic fracture quickly, allowing for emergent stabilization maneuvers and therapeutic interventions. Routine pelvic radiographs are not needed in stable trauma patients who will undergo an emergent CT of the abdomen and pelvis.
Pelvic fractures include those that involve a break in the pelvic ring, fractures of a single bone without a break in the pelvic ring, and acetabular fractures. Single bone fractures are described in Table 173-1.
Avulsion and Single Bone Fractures
|Favorite Table|Download (.pdf) Table 173-1
Avulsion and Single Bone Fractures
|Fracture ||Description/Mechanism of Injury ||Clinical Findings/Associated Injuries ||Treatment ||Disposition and Follow-Up |
|Iliac wing (Duverney) fracture ||Direct trauma, usually lateral to medial ||Swelling, tenderness over iliac wing; abdominal pain; ileus; acetabular fractures; serious injury infrequent ||Analgesics, non-weight-bearing until hip abductors pain-free, usually nonoperative ||Discharge with orthopedic follow-up in 1–2 weeks; admit for open fracture or concerning abdominal examination |
|Single ramus of pubis or ischium ||Fall or direct trauma in elderly; exercise-induced stress fracture in young or in pregnant women ||Local pain and tenderness; may have inability to ambulate ||Analgesics, crutches ||Discharge with PCP or orthopedic follow-up in 1–2 weeks |
|Ischium body ||External trauma or from fall in sitting position; least common pelvic fracture ||Local pain and tenderness; pain with hamstring movement ||Analgesics, bed rest, donut-ring cushion, crutches ||Discharge with orthopedic follow-up in 1–2 weeks |
|Sacral fracture ||Transverse fractures from direct anteroposterior trauma; upper transverse fractures from fall in flexed position ||Pain on rectal examination; sacral root injury with upper transverse fractures; vertical fractures may transect the pelvic ring ||Analgesics, bed rest, surgery may be needed for displaced fractures or neurologic injury ||Discharge with orthopedic follow-up in 1–2 ...|
Pop-up div Successfully Displayed
This div only appears when the trigger link is hovered over.
Otherwise it is hidden from view.