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Pelvic Fracture Clinical Pathway – Emergency Department

Emergency Department Clinical Pathway for Evaluation/Treatment
of Children with Suspected Pelvic Fracture

  • Acute Complications
    • Most often from associated injuries
    • Hemorrhagic shock
    • Neurovascular injury
    • Infection
  • Long-Term Complications
    • Leg length discrepancy
    • Gait disturbance
    • Chronic low back pain
    • Acetabular fractures
      • Growth disturbance
      • Arthritis
Child with Suspected Pelvic Fracture After Blunt Force Trauma
 
 
 
 
Additional imaging studies as clinically indicated by Trauma team
Stable
Hemodynamics
 
 
Avulsion or iliac wing fracture
 
 
ED treatment, discharge home
 
 
Ortho follow-up, 1 wk
 
 
Stable pelvis ring fracture
 
 
Admit Floor Trauma Service
PICU as indicated for other injuries
 
 
PT consult
Weight bearing pelvic films, after PT consult
 
 
Possible unstable fracture
 
 
Admit PICU, Trauma Service
 
 
Pelvis CT, no contrast, with 3D reconstructions
Consider exam under anesthesia
 
Unstable
Hemodynamics
 
 
  • Fluid resuscitation
  • Packed RBCs
  • Assess other causes of bleeding
 
 
 
 
Child
Stabilizes
Child Remains
Unstable
 
 
 
 
Stable Fracture
 
 
 
 
CTA with IV contrast
Use pelvic binder or
Immobilize with sheet
CTA with IV contrast
 
 
 
 
Stable Fracture
 
 
 
 
CTA with IV contrast
Use pelvic binder or
Immobilize with sheet
CTA with IV contrast
Consider IR consult for possible embolization
Admit PICU
Trauma Service
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