MINORS MANUAL
Pelvic injuries involve trauma to the pelvic bones, including the ilium, ischium, pubis, and sacrum, as well as the surrounding ligaments, blood vessels, and organs. These injuries are often seen in high-impact accidents, such as motor vehicle collisions, falls from heights, or crush injuries, and can be life-threatening due to the risk of massive haemorrhage, organ damage, and neurovascular compromise.
Diagnosis
Diagnosis of pelvic injuries requires a thorough physical examination and imaging studies. Clinically, patients may present with pelvic pain, instability, bruising, and signs of shock due to internal bleeding. Imaging, including X-rays, computed tomography (CT), and sometimes magnetic resonance imaging (MRI), is essential to assess the extent of fractures, soft tissue damage, and any associated injuries to the organs in the pelvic cavity, such as the bladder or bowel.
Differential Diagnosis
Pathology | Key Characteristics |
|---|---|
Pelvic fracture | Pain, instability, swelling, difficulty in movement or weight-bearing |
Hip dislocation | Shortened, externally rotated leg, severe pain, inability to move the limb |
Sacral fracture | Localised sacral pain, potential neurological symptoms like numbness or weakness |
Urethral injury | Blood at the urethral meatus, difficulty urinating, commonly associated with pelvic trauma |
Emergency Management
Initial ABC assessment (airway, breathing, circulation): Prioritise life-threatening injuries. Pelvic trauma may cause significant internal bleeding, so fluid resuscitation and stabilisation are critical.
Pelvic stabilisation: Apply a pelvic binder or sheet to stabilise the pelvis and reduce bleeding in unstable fractures.
Control haemorrhage: Manage internal bleeding with fluid resuscitation, blood transfusion, and, if necessary, embolisation or surgical intervention to control pelvic bleeding.
Neurological assessment: Check for any signs of nerve damage, such as numbness, tingling, or motor deficits, which may indicate sacral nerve involvement.
Urinary and rectal evaluation: Assess for bladder or bowel injury, including haematuria (blood in the urine), difficulty urinating, or rectal bleeding. A Foley catheter should not be inserted if urethral injury is suspected; consider a retrograde urethrogram instead.
Imaging: Perform an X-ray or CT scan to assess the fracture pattern, evaluate organ damage, and guide further treatment.
Definitive Treatment
Definitive treatment depends on the type and severity of the injury. Non-displaced or stable pelvic fractures may be managed conservatively with bed rest, pain management, and physical therapy. Displaced or unstable fractures often require surgical intervention, including open reduction and internal fixation (ORIF) or external fixation to stabilise the pelvis.
Patients with pelvic injuries may also require multidisciplinary care, including urological, vascular, or neurological surgery, especially in cases of organ damage, neurovascular compromise, or associated spinal injuries. Long-term rehabilitation is essential for restoring mobility and function.
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