Chapter 55 Pelvic Fracture (Case 38)
Case: A 64-year-old female T-boned on the passenger side of the car in a motor vehicle crash.
Differential Diagnosis
| Stable pelvic fracture | Unstable pelvic fracture |
| Open pelvic fracture | Bladder/urethral injury |
PATIENT CARE
History
• What was the mechanism of the injury? Was there a high-energy trauma such as a motor vehicle crash or a fall from a height? If it was a motor vehicle crash, was the patient belted or not? Was the patient in the vehicle or a pedestrian? Or was it a low-energy trauma such as a trip and fall?
Physical Examination
• Breathing: Check that breathing is not labored and/or tachypneic. Breath sounds should be equal bilaterally, and the trachea should be midline.
• Circulation: Check the blood pressure, heart rate, and pulses. Hypotension can be an indication of hemorrhage in the trauma patient.
• Exposure: Don’t forget to roll the patient to check the back and buttocks. The secondary survey should include the other pertinent body systems, particularly the nervous system, musculoskeletal system, and genitourinary systems.
• Leg length discrepancy can be an indication of injury to the extremities or can occur in vertically unstable pelvic fractures.
• Pelvic instability to gentle distraction and compression at the iliac crests should be checked, but not repeatedly.
• Motor function, sensation, and reflexes should be checked, particularly in the lower extremities in a patient with a pelvic fracture. A footdrop from sciatic nerve injury may occur, or concomitant spinal injury may lead to abnormal neurological examination results.
• A rectal examination to check for bleeding and sacral motor function is necessary, as is a vaginal examination to check for bleeding. Bleeding in these areas may indicate an open pelvic fracture.
