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
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
  • Pelvic fracture with hemodynamic instability that is unresponsive to a pelvic binder
ID Consult
  • Open pelvic fracture
Interpreting Pelvic Films
Inpatient Care Tips
Patients ≥ 15 years, Transport Request
  • Refer call to Orthopaedics on-call
ATLS Survey
  • Hemodynamic Stability
  • Pain Management
ED Trauma Order Set
  • Trauma Labs
  • X-rays including AP Pelvis
  • Trauma
  • Orthopaedics
  • Consider Urology
  • Consider IR if hemodynamic concerns
Additional imaging studies as clinically indicated by Trauma team
Avulsion or Iliac Wing Fracture
ED Treatment, Discharge Home
Ortho Follow-up, 1 week
Stable Pelvis Ring Fracture
Admit Floor, Trauma Service
PT Consult
Weight Bearing Pelvic Films, after PT consult
PICU as indicated
Possible Unstable Fracture
Admit PICU, Trauma Service
Pelvis CT, no contrast, with 3D reconstructions Consider exam under anesthesia
Fluid resuscitation
Packed RBCs as indicated
Assess other causes of bleeding
Patient Remains
Stable Fracture
CT w/IV Contrast
Use Sheets in a Kocher
CT w/IV Contrast
Stable Fracture
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
Revised: April 2020
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