Pelvic trauma - detailed resuscitation guidance
Pelvic fractures range from low‑energy avulsion injuries to life‑threatening pelvic ring disruptions.
The pelvis contains major vascular and visceral structures; unstable ring injuries may produce large occult haemorrhage from pelvic veins, the presacral plexus, cancellous bone or, less commonly, arterial branches of the internal iliac system.
Early recognition, rapid mechanical stabilisation and timely escalation to definitive haemorrhage control are frequently lifesaving. Follow ABCDE while coordinating urgently with trauma surgery, orthopaedics and interventional radiology (IR). (NICE NG37; Resuscitation Council UK)
Anatomy and haemorrhage considerations
- Pelvic ring: two innominate bones (ilium, ischium, pubis) and the sacrum form a ring; posterior ring (sacroiliac joints, sacrum) injuries commonly produce major haemorrhage.
- Ligaments: sacroiliac, sacrotuberous and sacrospinous ligaments determine stability and the likely displacement pattern (anteroposterior, lateral compression, vertical shear forces).
- Vascular sources: most major bleeding is venous or from cancellous bone (reduced by ring closure and packing), but arterial bleeding (internal iliac branches) can occur and is amenable to embolisation.
- Structures at risk: bladder, urethra, bowel, sciatic and pudendal nerves; open perineal wounds suggest an open pelvic fracture and contamination.
Clinical assessment - what to look for
- Mechanism:
- High‑energy trauma (road traffic collisions, falls from height) → suspect unstable pelvic injury.
- In elderly/osteoporotic patients low‑energy falls may still cause significant fractures.