Child with Suspected Pelvis Fracture Clinical Pathway — Emergency

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Child with Suspected Pelvic Fracture after Blunt Force Trauma

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

Open pelvic fracture
Interpreting Pelvic Films

Inpatient Care Tips
Patients ≥ 15 years, Transport Request

Refer call to Orthopaedics on-call

When to Suspect a Pelvic Fracture

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

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 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

Unstable
Hemodynamics

Fluid resuscitation
Packed RBCs as indicated
Assess other causes of bleeding

Patient
Stabilizes

Patient Remains
Unstable

Stable Fracture

Unstable Fracture

CT w/IV Contrast

Use Sheets in a Kocher
CT w/IV Contrast

Stable Fracture

Unstable 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
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

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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.

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