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Clinical Features

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.

Table 173-1

Avulsion and Single Bone Fractures

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