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
- 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
Additional imaging studies as clinically indicated by Trauma team
Stable
Hemodynamics
Hemodynamics
Avulsion or iliac wing fracture
ED treatment, discharge home
Ortho follow-up, 1 wk
Stable pelvis ring fracture
PT consult
Weight bearing pelvic films, after 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
Consider exam under anesthesia
Unstable
Hemodynamics
Hemodynamics
- Fluid resuscitation
- Packed RBCs
- Assess other causes of bleeding
Child
Stabilizes
Stabilizes
Child Remains
Unstable
Unstable
Stable Fracture
CTA with IV contrast
Stable Fracture
CTA with IV contrast
Consider IR consult for possible embolization
Admit PICU
Trauma Service
Trauma Service
Evidence
- A Comparison Study of Pelvic Fractures and Associated Abdominal Injuries Between Pediatric and Adult Blunt Trauma Patients
- Paediatric Pelvic Fractures: How Do They Differ from Adults?
- Pelvic Fractures
- Pelvic Fractures in Paediatric Polytrauma Patients: Classification, Concomitant Injuries and Early Mortality
- Paediatric Pelvic Fractures — an Updated Literature Review