Pediatric emergency medicine trisk 3485 3485
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Injuries of the Pelvis
Goals of Treatment. One of the initial goals in the treatment of pelvic fractures is
the rapid identification and management of any ongoing bleeding associated with
pelvic fractures or other concurrent injuries. Life-threatening hemorrhage from
pelvic fractures is unusual, but if present, must be identified with timely treatment
and resuscitation.
CLINICAL PEARLS AND PITFALLS
The presence of bilateral anterior and posterior fractures is associated
with the greatest risk of hemorrhage and intra-abdominal injury.
Isolated pubic ramus fractures have the lowest risk for these.
In the setting of concern for pelvic fracture, a patient with blood at the
urethral meatus should be evaluated for injury to the genitourinary
structures.
In the absence of abnormalities on physical examination of the pelvis,
lower extremity fracture, or other indication for abdominopelvic CT, the
risk of pediatric pelvic fracture is low.
Current Evidence. Pelvic fractures are typically caused by high-energy
mechanisms of injury that can be associated with multisystem trauma, including
to the head, abdomen, genitourinary (e.g., urethra), and vascular structures. There
should be a high index of suspicion for potentially life-threatening soft tissue or
vascular injury. The role of routine screening pelvic x-rays in the setting of
trauma has been questioned. In the conscious patient with a normal pelvis and
lower extremity examination, routine x-rays of the pelvis may not be indicated, as
the physical examination has a high specificity and negative predictive value for
pelvic fractures, but only moderate sensitivity. Furthermore, if a patient with
multisystem trauma undergoes an abdominal–pelvic CT scan for evaluation,
screening radiographs are not necessary as the sensitivity of CT for detecting
pelvic fractures is higher than pelvic radiographs.
Clinical Considerations
Clinical recognition . The pediatric pelvis has greater elasticity of the sacroiliac
joint and the symphysis and more plasticity of the pelvic bones than the adult
pelvis. As a result, a higher-energy impact is required to cause a fracture
