injuries poisoning
Pelvic Fractures
Treatment of Pelvic Fractures
For stable fractures, usually only symptomatic treatment For unstable fractures, external fixation or open reduction with internal fixation (ORIF) For significant hemorrhage, external fixation or sometimes angiographic embolization or pelvic packing For pelvic fractures, an orthopedic or trauma surgeon is consulted. Almost all patients with pelvic fractures (other than stable fractures, eg, minimally displaced fractures of the pubic rami) should be admitted for observation to watch for continued bleeding. Stable pelvic fracturesoften require only symptomatic treatment, particularly when patients can walk unaided. Acetabular fractures result from a high-energy injury (eg, a fall from height or a motor vehicle crash). Acetabular fractures are treated surgically if the fractures are displaced or instability persists after closed reduction. Acetabular fractures with posterior wall injuries are managed nonsurgically. Orthopedic consultation is recommended for these injuries. Unstable pelvic fracturesshould be wrapped (eg, in sheets) or stabilized with a commercially available pelvic binder as soon as possible in the emergency department; such stabilization can often decrease or stop bleeding. Orthopedic consultation is needed when pelvic fractures are unstable to determine whether ORIF or external (percutaneous) screw fixation should be done. External screw fixation can be done in the emergency department by orthopedic surgeons. Indications for external screw fixation include Ongoing hemorrhage or hemodynamic instability, particularly in patients with large pelvic disruption Multisystem trauma Need for stabilization before transfer for definitive care External screw fixation reduces morbidity and the length of stay in a hospital. Wrap the pelvis (eg, in sheets) or apply an external fixator as soon as possible to stabilize an unstable pelvic fracture. If bleeding persists, angiographic embolization or surgery for pelvic packing and/or internal pelvic fixation is required. Unstable fractures without significant hemorrhage require a pelvic binder, applied in the emergency department; ORIF is the definitive treatment. Other associated injuries are treated. 