12 - Severe pelvic trauma

Summary

This chapter discusses the diagnosis, evaluation and management of pelvic trauma. The most commonly used classification system for pelvic fractures is the Young-Burgess system. This system categorizes injuries on the basis of mechanism of injury and can be used to predict the risk of blood loss. Severely injured patients are often hypotensive and require early intubation and fluid resuscitation. It is important to keep pelvic fractures high in the differential diagnosis when evaluating any patient with multiple injuries. Tachycardia is usually the first abnormal vital sign that may lead to the diagnosis of acute blood loss in severe pelvic trauma. The primary goal is early reduction of pelvic volume, which decreases venous hemorrhage through tamponade and clot formation, thereby improving mortality. Circumferential wrapping of the pelvis with a sheet is an easy and inexpensive option for pelvic binding. Commercially available pelvic binders are also an excellent option.