Pelvic Fracture Clinical Pathway – Emergency Department

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

When to Suspect a Pelvic Fracture

ATLS Survey
- Hemodynamic Stability
- Pain Management
ED Trauma Alert Order Set
- Trauma Labs
- X-rays including XR pelvis 1 view AP
  Tips on Interpreting Pelvic Films
Consults
- Trauma
- Orthopedics
- ID for open fracture
- Additional consults as indicated

Assess Hemodynamics

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

Unstable Fracture

CTA with IV contrast

Use pelvic binder or
Immobilize with sheet
CTA with IV contrast

Stable Fracture

Unstable 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

Posted: April 2018
Last Revised: July 2025
Authors:
Editors: Clinical Pathways Team

Evidence

CHOP Program

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.