Iliac wing (Duverney) fracture | Direct trauma, usually lateral to medial | Analgesics, nonweightbearing until hip abductors pain-free, usually nonoperative | Discharge with orthopedic follow-up in 1 to 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 | Analgesics, crutches | Discharge with PCP or orthopedic follow-up in 1 to 2 weeks |
Ischium body | External trauma or from fall in sitting position; least common pelvic fracture | Analgesics, bed rest, donut-ring cushion, crutches | Discharge with orthopedic follow-up in 1 to 2 weeks |
Sacral fracture | Transverse fractures from direct anteroposterior trauma; upper transverse fractures from fall in flexed position | Analgesics, bed rest, surgery may be needed for displaced fractures or neurologic injury | Discharge with orthopedic follow-up 1 to 2 weeks; orthopedic consultation for displaced fractures or neurologic deficits |
Coccyx fracture | Fall in sitting position; more common in women | Analgesics, bed rest, stool softeners, sitz baths, donut-ring cushion | PCP or orthopedic follow-up in 2 to 3 weeks; surgical excision of fracture fragment if chronic pain |
Anterior superior iliac spine | Forceful sartorius muscle contraction (eg, adolescent sprinters) | Analgesics, bed rest for 3 to 4 weeks with hip flexed and abducted, crutches | Discharge with orthopedic follow-up in 1 to 2 weeks |
Anterior inferior iliac spine | Forceful rectus femoris muscle contraction (eg, adolescent soccer players) | Analgesics, bed rest for 3 to 4 weeks with hip flexed, crutches | Discharge with orthopedic follow-up in 1 to 2 weeks |
Ischial tuberosity | Forceful contraction of hamstrings | Analgesics, bed rest for 3 to 4 weeks in extension, external rotation, crutches | Discharge with orthopedic follow-up in 1 to 2 weeks |