1. THE ASSESSMENT AND TREATMENT OF UNSTABLE PELVIC INJURIES

2. Despite advances in diagnostic and operative techniques, pelvic injuries still account for 39% of al blunt trauma deaths

3. Pelvic injuries have a 9% mortality rate overall, but unstable fractures have a 30+% death rate

4. 90% of patients have a second injury

6. Anterior View
Posterior View
Ligaments and anterior structure provides for 40% of pelvic stability
Ligaments and posterior structure provides for 60% of pelvic stability

7. Types of Pelvic Fractures
Anteroposterior Compression
Lateral Compression
Vertical Shear

8. Causes are generally frontal impact MV crashes, especially front seat occupants
Severity is governed by the abount of ligament damage and widening of symphesis pubis
Higher energy transfer is required the higher up the scale you go
Type III will almost always have second injury due to this transfer including pelvic and abdominal organ damage, severe bleeding and nerve damage

9. Caused by lateral impact, generally side impact MV crashes or pedestrian hit by a vehicle
Again, there is more energy transfer the higher up the scale you go
Associated organ, vessel and nerve damage
The energy transfer may cause collateral fractures, i.e. one the opposite side of impact

10. Caused by a fall from a height
Damage dependant upon fall distance and area of impact
Displacement of iliac may cause severe vessel and nerve damage

11. Prehospital Assessment
MOI—most common is a motor vehicle or pedestrian collision
MOI—second most common are high level falls or low-level involving geriatric patients
Most common complaint is pelvic pain. Secondary pain in back, hip or groin are also prevalent
Leg-length discrepancy present?
Bruising over flank, bony prominences of pelvis, pubis, perineum or scrotum
Don’t forget a full assessment—remember there is a 90% chance of other injuries!
“rocking” or “springing” the pelvis is very unreliable
Only 37 – 67% reliable (Gonzalez, 2002)
Maryland Protocols state that palpation shall be attempted only once
May dislodge clots or promote further blood loss

12. Associated Injuries Thorax 30-50% Abdomen 30-50% Extremity 50 – 70%
Head
40-50%
Thorax
30-50%
Abdomen
30-50%
Extremity
50 – 70%

13. Hemorrhage Control & Treatment
Internal hemorrhage is a major cause of death within the first 24 hours
Traditional treatments were internal rotation of the lower limbs followed by wrapping with a bedsheet or PASG/MAST
Studies show that these had inconsistent results, questionable effectiveness and the possibility of overcompression—no mortality benefit or reduction in hospital stay

14. 2. If Local Jurisdiction permits, a pelvic binder should be applied
1. Head-to-toe Survey
2. If Local Jurisdiction permits, a pelvic binder should be applied
This is a treatment intervention-not a packaging intervention—
APPLY EARLY
This is an Optional Supplemental Program under MIEMSS Protocols as of July 2019 applicable to all EMS proviedrs trained in proper use of the devices
3. Patient should be moved to a long board via scoop stretcher
Do not log roll—remember minimal movement
4. ALS interventions may include IV establishment and pain management

15. Maryland Medical Protocols

16. Maryland Medical Protocols

17. Practical Application

18. Review Identification of Mechanisms of Injury Anatomy of the pelvis
Appropriate pre-hospital treatment of suspected pelvic injuries
Maryland EMS Protocols governing commercial pelvic binders
Proper application of pelvic binders

19. High energy MVA’s and falls have increased the number of pelvic injuries encountered in the pre-hospital setting. These potentially life-threatening events can be properly assessed and treated by pre-hospital providers, thereby reducing overall morbidity and mortality.