Mechanism of Injury

Pelvic Fractures

Mechanism of Injury

1) Falls from 20 feet or higher for adults or 10 feet or higher for children.

2) Motor vehicle crashes.

3) Pedestrian-vehicle crashes.

4) Pelvic gun shot wounds.

5) Other types of high speed, blunt trauma to the pelvic area.

Significant Complications

1) Acute internal bleeding into the pelvic cavity, leading to shock.

2) Since the pelvis forms a ring, likely to fracture in more than one location.

3) Injuries to the genitalia are commonly associated with pelvic fractures.

4) Bladder injuries, indicated by blood in the urine or a significant decrease in urine output.

Assessment

1) As part of the over all assessment, check the integrity of the pelvis by placing your palms on the iliac crests and applying gentle, but firm inward pressure.

2) Bone crepitus, increased pain, or tenderness may suggest a pelvic fracture.

3) Palpate the pelvic bones gently, but do not press downward or outward which may worsen a fracture or increase internal damage.

4) Only perform one examination for pelvic fracture, since re-examination can loosen any clotting that has formed at a fracture site.

5) Monitor for shock (several liters of blood can accumulate in the pelvic cavity).

6) Rising pulse, falling systolic blood pressure, and decreasing level of consciousness are urgent warning signs.

Treatment

1) Pelvic fractures require urgent care and immediate evacuation as rapidly as possible.

2) Keep the patient on their back and in a position of comfort.

3) A MOI that causes a pelvic fracture most likely warrants spinal immobilization. To start with, apply a cervical collar.

4) If evacuation will be over a longer distance or rough terrain, stabilize the pelvis with a pelvic binder. There are commercial and improvised binders. Improvised binders include sheets or inflatable sleeping pads. A blanket is normally too thick to tie a knot using two corners.

5) Pad between the patient’s legs and tie the patients legs together at the knees and ankles.

6) Secure the patient to a back board, keeping the knees slightly flexed and filling in any voids.

7) Continuously monitor vitals and treat for shock.

Wilderness Issues

1) Most hiking or climbing parties will not have a pelvic binder or sheet with them, let alone a cervical collar or backboard. A pelvic binder can be improvised with a sleeping pad and anything that can be used to bind the pad around the pelvis. The binding material can be tightened using a stick, similar to a windlass used to tighten a tourniquet. If an inflatable sleeping pad is used, binding it first and then inflating the pad is recommended, but it seems like partially inflating it first would make it work better. A cervical collar can be made with a foam sleeping pad or a SAM splint if available.

2) If a sheet or something similar is available, the steps for creating a pelvic binder are:

A) Fold the sheet lengthwise until it is about 12 - 18 inches wide.

B) Place the sheet under the patient, with the top 1 - 2 inches of the sheet above the top of the iliac crest.

C) Draw the two ends of the sheet up and over the symphysis pubis and compress the trochanters of the femur. Twist the ends of the sheets to form a “rope.”

D) Gently pull the two ends of the twisted sheet tight.

E) Tie the two ends of the sheet using a square knot.

Use of the SAM Pelvic Sling