PELVIC TRAUMA

See also Pelvic Fracture Management Flow Chart

PRIMARY SURVEY/RESUSCITATION

Circulation

• Large bore IV x 2
• Blood grouping (> 6 units)
• Pelvic Binder/Sheet wrap to immobilise pelvic (Do not compress lateral compression fractures)

PXR (not indicated in an alert/conscious patient not complaining of pelvic pain)

Do not insert IDC if there is evidence of a fracture, meatal blood, scrotal/perineal haematoma or high riding prostate

(see Retrograde urethrogram, Retrograde cystogram)

If the urethrogram is abnormal then insert a suprapubic catheter)

(see insertion of suprapubic catheter)

SECONDARY SURVEY

• Do not spring an obviously broken pelvis (breaks clot and increases bleeding)
• Dress open wounds

INVESTIGATIONS

X-RAYS

• Oblique (Judet) views (for acetabular #)
• Inlet views (delineates A-P displacement)
• Outlet views (delineates vertical displacement)

Retrograde Cytourethrogram

CT pelvis

• Best modality to delineate significant pelvic #

CT abdomen with rectal contrast (in rectal injuries)

MANAGEMENT

See Classification of Pelvic Fractures

See Pelvic Fracture Management Flow Chart

OTHER MANAGEMENT

• IV antibiotic prophylaxis if compound # or concurrent rectal/vaginal injuries

REFERRAL/DISPOSITION

• Admit/Transfer major injuries to specialist centre
• Early surgical/urological involvement in pelvic visceral injuries
• Any patient that cannot ambulate requires admission