The clinical presentation is consistent for an anterior-posterior compression (APC) pelvic injury. The patient has been hemodynamically stabilized and the next step in treatment is a CT scan of chest, abdomen, pelvis to rule out other life threatening injuries.
APC injuries are highly unstable and can produce high mortality rates by pelvic exsanguination. Pelvic venous bleeding is far more common than arterial bleeding. The initial treatment intervention should be to reduce the pelvic volume by any means possible (sheet, binder, ex-fix) to reduce further intrapelvic bleeding. After application of the pelvic sheet in the above scenario, the patient has become stabilized and can undergo further workup to rule out other life threatening injuries.
Illustration A is a useful algorithm for treating trauma patients with pelvic injuries.
Answer 2: If the patient is hemodynamically stable there is no need for immediate pelvic fixation.
Answer 3: If the patient is hemodynamically stable there is no need to change to a pelvic binder.
Answer 4: If pelvic volume reduction failed to stabilize the patient, and other sources of hemorrhage, such as chest or abdomen were ruled out with radiographs or FAST exam, pelvic angiography and embolization would be the next appropriate step to treat potential pelvic arterial injury.
Answer 4: There is no role for acute definitive open reduction internal fixation.
Scalea T, Burgess A; Pelvic Fracture; 824-5 Trauma eds Mattox, Feliciano, Moore McGraw Hill, NY 1999
Browner BD, Jupiter JB (et al): Skeletal Trauma ed 2. Philadelphia, PA WB Saunders, 1998 p 133-144
Kellam JF, Fischer TJ (et al) Eds. OKU Trauma 2. Rosemont, IL, AAOS 2000, p 229-237