ED Pathway for Evaluation/Treatment of a Child 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
Urology Consult
  • Blood in urine
  • Blood meatus, vagina
  • Perineal, penile hematoma
  • Fx pubic ramus, symphyseal diastasis
  • X-ray suggestive of bladder neck injury
  • Unable to void
IR Consult
ID Consult
Inpatient Care Tips
Patients ≥ 15 years, Transport Request
  • Refer call to Orthopaedics on-call
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ATLS Survey
  • Hemodynamic Stability
  • Pain Management
ED Trauma Order Set
  • Trauma Labs
  • X-rays including AP Pelvis
Consults
  • Trauma
  • Orthopaedics
  • Consider Urology
  • Consider IR if hemodynamic concerns
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Additional imaging studies as clinically indicated by Trauma team
Stable
Hemodynamics
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Avulsion or Iliac Wing Fracture
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ED Treatment, Discharge Home
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Ortho Follow-up, 1 week
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Stable Pelvis Ring Fracture
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Admit Floor, Trauma Service
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PT Consult
Weight Bearing Pelvic Films, after PT consult
PICU as indicated
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Possible Unstable Fracture
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Admit PICU, Trauma Service
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Pelvis CT, no contrast, with 3D reconstructions Consider exam under anesthesia
 
Unstable
Hemodynamics
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Fluid resuscitation
Packed RBCs as indicated
Assess other causes of bleeding
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Patient
Stabilizes
Patient Remains
Unstable
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Stable Fracture
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CT w/ IV Contrast
Use Sheets in a Kocher
CT w/ IV Contrast
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Stable Fracture
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CT w/ IV Contrast
Use Sheets in a Kocher CT w/ IV Contrast
Consider IR Consultation for possible embolization
Admit PICU
Trauma Service
Patients > 15 yrs
Transport requests should be referred to Orthopaedics on-call Orthopaedic Attending consults Penn Presbyterian about transfer
Posted: April 2018
Authors: L. McNeely, CRNP; K. Baldwin, MD; M. Wood RN; J. Lavelle MD, J. Callahan MD; T. Metjian, PharmD;
V. Ho Fung, MD; T. Kolon, MD; D. Perks, CRNP