Signs and symptoms:
As with many of the other injuries, the clinician will need to utilise several factors to determine whether a pelvic injury has occurred and to what severity. Considering the MOI and surrounding factors, and if the patient has any risk factors such as advanced age, the clinician can consider what injuries may have occurred. More obvious signs and symptoms for pelvic injury include:
Management:
High-energy pelvic trauma is likely to cause damage and affect other parts of the body. The lower abdominal region and lower limbs will likely suffer injury and cause a polytrauma scenario. Managing the primary survey and any deficits identified are important to try and maintain patient stability. Further considerations are needed, such as oxygen administration in major trauma, management of blood pressure and a targeted systolic of 60 mmHg or central carotid pulse should be aimed for in penetrating torso trauma, and systolic of 90 mmHg or peripheral radial pulse in blunt trauma or penetrating limb trauma. Tranexamic acid would likely be administered due to the potential for major pelvic haemorrhage, and analgesia may be required for pain relief.
A pelvic binder is an important tool for the management of pelvic trauma and fractures. As discussed, the pelvic cavity has a large collection of blood vessels and tissues. Any fracture or disruption to the area could cause the potential for major internal bleeding. With an ‘open book’ fracture also present, where the skeletal pelvic structure has opened outwards of itself, the potential space for blood loss increases. An open book fracture can typically be seen by deformity and an ‘open’ look of the pelvic region, legs and feet may also be splayed and turned outwards. By applying a pelvic binder, this helps bring together the pelvis and somewhat stabilises it, reducing potential blood loss and space for blood to collect.
There are multiple types of pelvic binders available but all perform the same task. When applying the binder, it should be to skin level, and sited so that the centremost part covers where the greater trochanters would be.
Considerations should be made to not log roll the patient on extrication as movement may disrupt any clots already formed. If a log roll is required in order to move the patient onto a scoop, then a maximum of 15⁰ tilt either way can be considered.
Consideration should also be made when looking to use traction splints on lower limbs as this may require putting pressure against the pelvis for the traction to work, depending on the equipment. Pressure against a fractured pelvis may cause structural disruption and the breaking of any clots formed.