Pelvic Fracture Hemorrhage
Standardize treatment of traumatic pelvic injuries with hemorrhage.
Updated: 04/28/2025
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⚠️ ALL pelvic fractures require immediate orthopedic surgery consultation.
🩸Initial Resuscitation
▼- 2 large bore IVs (IJ/subclavian > femoral)
- Early MTP — 1:1:1. TXA 2g IV all at once.
- Avoid crystalloid
🦺Pelvic Binder
▼- All unstable (SBP <90) patients
- Position over greater trochanters
- Repeat XR to confirm reduction — leave until ortho evaluation
- Have a binder available for stable patients with high-bleed-risk patterns (APC / vertical shear)
- Can tape legs internally rotated for further pelvic reduction
- Do NOT remove for procedures or surgery
📈Escalation for Continued Instability
▼1
Preperitoneal Packing (PPP)
Hemodynamically unstable not responding to binder + resus.
2
External Fixation
Ortho + trauma attending discretion.
3
Angioembolization (IR)
Indicated for: pelvic extravasation on CT or a very large pelvic hematoma; signs of ongoing pelvic hemorrhage even without CT extravasation; or hemodynamic instability from pelvic bleeding. Selective embolization is preferred over non-selective.
4
Internal Iliac Ligation
Salvage only — patient in extremis.
💊
Open Pelvic Fx Antibiotics: Cefazolin 2g IV (3g if >120kg) within 1h. Vaginal/rectal involvement: add Metronidazole 500mg IV. PCN allergy: Vancomycin. Tetanus booster within 3h if indicated.
🧭Fracture Pattern (Young-Burgess)
▼- Lateral compression (LC) II / III
- Anteroposterior compression (APC) II / III — “open book”, greatest hemorrhage risk
- Vertical shear
- Combined mechanical patterns
🔎Physical Exam & GU Workup
▼- Assess pelvic skin and soft tissue; evaluate leg lengths
- Rectal exam for blood or evidence of open fracture
- Vaginal exam for signs of open fracture
- Males with blood at the meatus: Trauma Attending decides foley attempt vs urology consult
- Urinalysis and foley placement
- CT cystogram if bladder injury suspected
- Urology consult for urethral trauma
- Status
- AHS Official Protocol
- Source
- Management_of_Pelvic_Injuries_3_2025.docx
- Last reviewed / updated
- 04/28/2025