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.