Pelvic and Acetabular Fracture Guidelines
VBMC TRAUMA CARE SERVICES GUIDELINE
TITLE: Pelvic and Acetabulum Fracture Guideline
PURPOSE: Provide an evidence-based approach to the acute management and
hemorrhage control of traumatic pelvic ring injuries and acetabular fractures.
GUIDELINE:
Initial Management:
- Follow
established ATLS protocols, including the completion of the primary survey
and obtaining an AP pelvis radiograph.
- If
pelvic fracture suspected or confirmed on x-ray, the pelvic fracture
algorithm will guide the appropriate course of action for acute
management.
- A
pelvic binder or sheet wrap can be placed at any point if unstable pelvic
fracture is suspected.
- The
determination of whether acute pelvic stabilization is necessary is at the
discretion of the consulting orthopedist. Definitive fixation of the
injury will be determined by the Orthopedic Trauma Service.
Radiographic Evaluation:
- Initial
AP pelvis radiograph on presentation
- Trauma
CT scans must include thin slices of pelvis
- Additional
imaging at discretion of consulting orthopedist
Pelvic Binder Management:
- Management
of the pelvic binder, including determination of when to
discontinue/remove, shall be the
responsibility of the Orthopedic Trauma Service.
- Ideally,
pelvic binders should not be used for more than 24hrs, but if needed for a
longer duration, this will be documented by the Orthopedic Trauma Service
and skin integrity needs to be checked every 12 hours.
- Patients
requiring pelvic binder should be observed in the ICU.
Additional Management Recommendations:
• Foley catheter must be placed as part of trauma resuscitation.
o If blood at urethral meatus or inability to pass catheter,
obtain retrograde urethrogram to rule out urethral injury.
o If gross hematuria is present, obtain cystogram to rule
out bladder injury.
o Urethral/bladder injuries warrant urology consultation in
collaboration with consulting orthopedist. • Perineal and genital examination
and digital rectal exam (DRE) are mandatory in patients with pelvic
trauma.
o If blood identified on DRE, patient will need sigmoidoscopy to rule out
pelvic fracture-related open injury.
• Open pelvic fractures are Type III injuries and the appropriate antibiotics
initiated per Open Fracture Antibiotic Guideline.
Management of Acetabular Fractures with Hip Dislocation:
- Hip
dislocations should be reduced as soon as medically possible upon
presentation, but no longer than 12 hours from injury. Confirm reduction
with AP pelvis radiograph.
- Hip
reduction should be completed in trauma bay under sedation prior to
obtaining trauma CT scans. If this is not possible, obtain a
post-reduction CT pelvis.
- After
reduction, place a knee immobilizer on injured extremity.
- Skeletal
or Buck’s traction may be necessary at discretion of orthopedist.