Pelvic injuries are more common in patients with multiple trauma. It can involve the soft tissues as well as pelvic fractures, especially in high velocity injuries.

Clinical management issues to consider

Obtain knowledge regarding:

1. mechanism of injury
2. type of soft tissue injury / fracture:
• genito-urinary
• gastro-intestinal
• neurological
• pelvic fracture:
• acetabular
• stable pelvic ring fracture – anterior or posterior
• unstable pelvic ring fracture – anterior or posterior
3. orthopaedic / urology / gynaecology / gastro-intestinal treatment received:
• review X-rays / CT scans / MRI scans
• review operation reports if applicable
• discuss with surgeons details of operative findings and follow-up imaging required
4. normal course of healing for that injury / fracture, complications and expected outcomes

Acute stage management principles:

1. pain relief
2. monitor pulse, blood pressure and haemoglobin level
3. input / output charting including management of haematuria and urinary catheter (if urethral damage sustained)
4. consider paralytic ileus
5. document American Spinal Injuries Association (ASIA) score if neurological damage sustained

Rehabilitation MDT goals:

1. pain relief:
   • pain relief ladder: paracetamol, NSAIDs, opiates
2. prevent complications
3. maintain / restore range of movement (ROM) of joints
4. muscle strengthening
5. personal care and gait retraining

Watch out for complications:

1. local:
• blood vessel damage: monitor circulation
• nerve damage: Please refer to spinal cord injury guidelines regarding bowel and bladder management. Consider urology and gastro-intestinal surgery input as indicated eg. stoma care
• stiffness of joints and muscle atrophy
• wound infection – swab for culture and sensitivity (C&S) and start systemic antibiotics
• pin site infection if an external fixator is used, swab for C&S and discuss with orthopaedic team starting systemic antibiotics
• metal work loosening or damage
• delayed union which can progress to non-union
• malunion: monitor for fracture redisplacement
• genito-urinary, eg:
• urethral stricture if urethral trauma sustained
• testicular haematoma
2. systemic:
• deep vein thrombosis (DVT) / pulmonary embolism (PE)
• anaemia
• fat embolism
• pneumonia
• urinary tract infections
• constipation
• pressure sores

Mobilisation:

1. Can be a progression from complete bed rest to assisted transfer activities, non-weight bearing ambulation, toe touch, partial weight-bearing, weightbearing as tolerated and finally full weight bearing.
2. There is no specific time for weight-bearing after a pelvic fracture. Decisions are in liaison with the orthopaedic team based on the type of fracture, type and quality of the fixation, bone condition, ability to control weight-bearing (eg. multiple injuries) and evidence of fracture healing.

Discharge planning

• Ensure communication and follow-up with orthopaedic surgery, urology, gynaecology, gastro-intestinal surgery and rehabilitation medicine (including physiotherapy and occupational therapy) teams as applicable.
• Make referrals to patients local area wheelchair services if applicable.