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Pelvis/Hip Case 10 Management

Pelvic fractures are typically associated with high speed mechanisms and other critical injuries so follow principles of ATLS first and foremost. Hemorrhage control can be achieved by embolization in Interventional radiology or by the surgeon in the operating room. These decisions depend on institutional resources and whether the patient has other surgical indications.

The specific definitive management of LC pelvic fractures requires orthopedic consultation. While pelvic binders or bed sheets are often recommended to stabilize unstable pelvic fractures in the ED, LC mechanisms are a scenario to try to avoid their use. These may displace fracture fragments further into the pelvis. Since pelvic volume is decreased in LC injuries, hemorrhage risk is considered lower, so the benefits of these devices are minimal in pure LC injuries.

Avoid Foley catheter placement until urethral injury has been ruled out if there is:

  • Blood at the urethral meatus
  • Inability to void
  • Gross hematuria
  • Straddle fractures, vertical shear fractures, or disruption of the anterior and posterior pelvic ring