What is the treatment for a pelvic fracture?

From the Guidelines

Treatment for a pelvic fracture should prioritize early external fixation of the pelvis in patients with severe pelvic trauma and haemodynamic instability to limit the expansion of the pelvic haematoma, as recommended by the most recent and highest quality study 1. The management of pelvic fractures requires a multidisciplinary approach, considering both the anatomy of the injury and its physiological and mechanical effects. For stable fractures, treatment typically involves:

• Pain management with medications like acetaminophen (500-1000mg every 6 hours) or NSAIDs such as ibuprofen (400-600mg every 6-8 hours)
• Rest and limited weight-bearing using crutches or a walker for 6-12 weeks
• Physical therapy to restore mobility and strength For unstable fractures, surgical intervention is necessary, which may include:
• External fixation (temporary stabilization with pins and an external frame)
• Internal fixation (plates and screws) These patients require hospitalization, often with initial blood transfusions if significant bleeding has occurred. Deep vein thrombosis prophylaxis with low molecular weight heparin (e.g., enoxaparin 40mg subcutaneously daily) is important during immobilization. Some key points to consider in the management of pelvic fractures include:
• The use of pelvic binders to reduce pelvic fracture and adduct lower limbs, which can be effective in controlling pelvic bleeding 1
• The importance of early surgical management with pelvic external fixation and direct preperitoneal pelvic packing (PPP) for hypotensive patients with hemodynamical and mechanical unstable pelvic ring injuries 1
• The need for a multidisciplinary approach, considering both the anatomy of the injury and its physiological and mechanical effects 1

From the Research

Treatment Options for Pelvic Fractures

• The treatment for pelvic fractures can vary depending on the severity and type of fracture, as well as the presence of associated injuries 2, 3, 4.
• For acute management, the principal consideration is the control of severe intrapelvic hemorrhage, which can be achieved through external fixation, closed reduction, or a combination of both 2.
• A protocol that combines early application of external fixation with closed reduction of the pelvic fracture has been shown to decrease the anticipated amount of intrapelvic hemorrhage 2.
• The use of a pelvic orthotic device (POD) has also been shown to be effective in reducing transfusion requirements and hospital length of stay in patients with life-threatening pelvic fractures 5.

Surgical Interventions

• Supplementary techniques of open reduction and internal fixation may be applied to appropriate complex fracture patterns once the general condition of the patient has stabilized 2.
• In cases of arterial injury, such as lesion of the external iliac artery, immediate surgery is mandatory to restore blood flow 6.
• Vascular surgery can be associated with pelvic fracture stabilization, depending on the type of injury 6.

Multidisciplinary Approach

• A multidisciplinary approach is required for the proper management of hemodynamically unstable patients with pelvic fractures, involving swift and adequate resuscitation, reversal of shock and acidosis, and rapid control of hemorrhage 4.
• Multimodality therapies, including external pelvic stabilization, angioembolization, and preperitoneal pelvic packing, can be useful adjuncts in the management of pelvic fractures 4.