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Pelvis/Hip case 11 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 pelvic fractures requires orthopedic consultation   Since pelvic volume is increased in APC injuries, hemorrhage risk is higher. APC injuries are the ideal injuries to place a pelvic binder or bedsheets to close the pelvis to temporize hemorrhage until definitive intervention.

Pelvic binders stabilize the pelvis rotationally but not vertically. Make sure to center the binder over the trochanters, not the iliac crests. Pelvic binders decrease pelvic volume and can control venous bleeding but likely won’t stop arterial bleeding.

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