Pelvic Fracture

1. Types
   1. Lateral Compression Pelvic Fracture
      1. Mechanism: Motor Vehicle Accident
      2. Pubic Ramus Fracture is most common manifestation
      3. Bladder injury or Urethral disruption are most common associated injuries
   2. Anterior Compression Pelvic Fracture (Open Book Fracture)
      1. Mechanism: Pedestrian struck by Motor Vehicle Accident
      2. Symphysis Pubis Fracture is most common manifestation
      3. Thoracic aorta rupture is an often associated injury
   3. Vertical Shear Pelvic Fracture
      1. Mechanism: High force injury
      2. Unstable Pelvis
      3. Associated with significant gastrointestinal and genitourinary injuries
2. Precautions
   1. All pevic Fractures (and femur Fractures) risk signficant hemorrhage
   2. All Pelvic Fractures are a risk for urologic, gastrointestinal and retroperitoneal injuries
   3. Pelvic Fracture may give a false positive Diagnostic Peritoneal Lavage
3. Exam
   1. Compress the Pelvis by pushing both iliac crests together with force
      1. Assess for anterior or posterior palvis injury
      2. If the Pelvis moves inward on compression, hold this position and apply a pelvic binder for stabilization
      3. Do not repeat this exam in an unstable Pelvis
   2. Perform a careful distal CMS exam
      1. Distal extremity circulation (pulses, Capillary Refill)
      2. Distal Motor Exam
      3. Distal Sensory Exam
4. Imaging
   1. Pelvis Xray
   2. CT Abdomen and Pelvis
      1. Defines Pelvic Fracture
      2. Defines associated genitourinary and intestinal injuries
   3. Diagnostic Peritoneal Lavage
      1. Mostly replaced by CT Abdomen and Pelvis
5. Management
   1. Pelvic binder for immediate stabilization
   2. Manage Hemorrhagic Shock
   3. Surgical consultation
      1. Trauma surgery, orthopedics, general surgery or urology depending on extent of injuries
   4. Consider intervention radiology for pelvic embolization if persistent bleeding