Ministry of Health

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 Published: 28/11/2011

Pelvic Trauma

The pelvis should be assessed clinically as part of the Secondary Survey.

1. Look         abrasion or bruising over bony prominences.
                    Scrotal or perineal haematoma.
                    Blood at the urethral meatus.
                    Leg length discrepancy
2. Feel/move posterior compression of iliac wings
                    medial compression of iliac wings
                    compression of pubic symphysis
                    hip flexion and rotation
                    rectal examination

All "impaired" patients and any patient with signs or symptoms of pelvic injury should have a plain AP x-ray of the pelvis. When fractures are identified, orthopaedic consultation is necessary.

If a patient with a pelvic fracture is haemodynamically unstable a DPL (supra umbilical) or FAST scan is required:
If grossly positive (DPL >10ml frank blood), the patient must go to the OR for a laparotomy.
If grossly negative pelvic angiography and embolisation of arterial bleeders is next step.

In major pelvic injury, stressing the pelvis should be avoided as it may dislodge vital clot.

Orthopaedic stabilisation of mechanically unstable pelvic fractures follows laparotomy or angiography to reduce venous loss (see algorithm).

Intensivist, orthopaedic and trauma specialists should be involved early.

Genitourinary injuries

Anterior pelvic fractures are associated with a high rate of bladder and urethral injuries.
Cystogram can be used to investigate these injuries. Gross haematuria with anterior pelvic fractures will likely have bladder rupture as a cause.

An alternative to cystography in the screening room is a CT cystogram. (The bladder is filled with 300 ml of contrast prior to obtaining a CT 'run' through the pelvis. Post-drainage views of the bladder are then taken). Views of the bladder during a standard trauma CT are not sufficiently sensitive or specific for bladder injury.

Retrograde urethrogram is required for the patient with: blood at the urethral meatus, scrotal bruising, high-riding prostate on PR or the stable patient with multiple grossly displaced superior and inferior pubic rami fractures.

Last updated on 28/11/2011