A pelvic fracture happens when the ring of bones connecting the spinal cord to the hip breaks. It could be due to high impact forces such as motor vehicle accidents, crashes, or falling from high elevations.
Individuals above 65 years are more susceptible to pelvic fractures from low impact than people of a younger age. Even though pelvic fractures contribute a small percentage of general injuries, the death rate in affected individuals is high.
Pelvic fractures are characterized according to how the bones break. There are three types of pelvic fractures: vertical shearing, anterior-posterior compression, and lateral compression.
All three types can either be stable or unstable fractures. Unstable fractures happen when the pelvic ring is fractured and displaced in two or more places. On the other hand, stable fractures don’t affect the pelvic ring and have slight displacement.
If you’re an emergency responder or a healthcare provider, here are four ways to manage a patient with a pelvic fracture:
1. Ascertain The Mechanism Of Injury
Determining the mechanism of injury helps to evaluate and manage a patient. Low-impact injuries differ from high-impact trauma, where severe internal damage and bleeding should be expected.
Conscious patients can experience pain in the hips, groin, lower back, and pelvis. Unlike high-energy injuries, where you can quickly ascertain fractures, low-impact fractures may need further investigation.
A patient with low-impact fractures may be able to walk and support his body weight with or without help.
2. Conduct A Physical Assessment
In case of high-impact trauma, you should examine the skin for degloving, contusions, swelling, and open wounds.
Degloved skin and open wounds often display ruptured and bleeding blood vessels. You can contain such bleeding with 25 second applications of a Sam Junctional Tourniquet.
Remember to assess the condition and alignment of the legs, which could be twisted or shortened due to high impact.
The pelvic deformity may not be visible at first sight, though it’s common in high-energy injuries. And if you palpate and notice the crepitus and tenderness of the sacrum, hips, iliac bones, and pubis, it could indicate some form of deformity.
You may need to take an anteroposterior pelvic x-ray to ascertain your worry. Remember also to assess the genitals and the perineum for patients involved in high-energy injuries.
In women, you should check for blood in the urine or vaginal bleeding. For men, it would be best to check for blood at the external urethral meatus, scrotal hematoma, and hematuria.
For a rectal assessment, check for any loss of perirectal sensation, palpable fractures, hematoma, and rectal bleeding.
3. Conduct A Diagnosis
Most high-impact pelvic fractures often cause damage to other body organs in the abdomen and chest. If your patient is unconscious or in shock, conduct a preliminary focused assessment sonography for trauma (FAST) examination.
Transfer the patient to an operating room (OR) for emergency surgery if the results show the presence of intra-abdominal fluid.
If you’re far away from a hospital or have access to surgical facilities, you should first resuscitate the patient and then call emergency services. For patients with low-impact pelvic fractures, process a computed tomography scan and an anteroposterior pelvic x-ray to help diagnose.
4. Offer Appropriate Treatment
In cases of active bleeding, immediately wrap a temporary pelvic binder (TPB) at the greater trochanter level to slow down the bleeding and stabilize the pelvic ring before transferring the patient to a hospital.
Stable patients can be wrapped in a sheet to make them comfortable during the transfer. However, wrapping patients in a sheet or the TPB can damage the tissues if the journey is long. In such situations, seek the doctor’s advice before taking any steps.
Patients with degloved skin or open fractures should be given prophylactic antibiotics to prevent infections. Similarly, an intravenous tranexamic acid administered within two hours of the incident can prevent excess hemorrhage.
Regularly assess the patient’s pain level, and if it’s high, especially in high-impact pelvic fractures, administer an intravenous morphine injection. Low-impact patients may survive on paracetamol, muscle relaxers, and opioids administered every seven hours.
Upon arrival at the hospital, and after the pelvic fracture is confirmed, remove the wrapping sheet and pelvic binder to prevent pressure sores. However, the orthopedic surgeon should devise a management plan beforehand if the fractures are unstable.
If the mechanism of injury is ascertained and you’ve performed a physical exam, wrap the patient with a temporary pelvic binder. If the patient is unconscious, try to resuscitate him. Then reexamine the hemodynamic status to establish if the patient is responding to medication.
Based on the results, professional healthcare providers will develop a treatment plan to help the patient recover. And if the fracture is worse, the surgeon may decide to do a replacement or repair the pelvic bones.
Generally, pelvic fractures are painful, agonizing, and sometimes fatal. But with prompt management and professional medical care, a patient may fully recover. Your winning point is mobilizing the appropriate tools and professionals and acting swiftly before the fracture worsens.
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