Pelvic Fractures

Pelvic fractures have a wide range of clinical significance—from small, non-displaced rami fractures to life-threatening anterior-posterior compression fractures with active hemorrhage. Pelvic ring fractures in the setting of high-energy trauma can be life threatening and are often associated with a significant risk of morbidity and mortality that can be lessened with early diagnosis and appropriate management. Pelvic instability with compression on physical exam is highly specific for unstable pelvic ring fractures (99%). According to retrospective data, however the sensitivity is quite low—only 26% sensitivity for detecting unstable fractures and 8% for stable fractures. Repeated compression should be avoided due to the risk of iatrogenic displacement of fractures. Associated injuries/diagnoses may include but are not limited to blunt chest trauma; hollow viscus or other abdominal, neurologic, long bone fractures; hemorrhagic shock; and urologic, gynecologic, or rectal injury. A thorough physical exam, careful monitoring of hemodynamic status, and early consultation with orthopedic surgery and trauma surgery are key to optimal management of pelvic fractures.