01Approach to the Critical Patient/attcp55

Hemorrhagic shock recognition

›Hemorrhagic shock criteria

›SBP < 90 mmHg or MAP < 65 mmHg

›Pelvic hemorrhage source — venous plexus 80%, arterial 20%

›Retroperitoneal hematoma may tamponade bleeding transiently

›HR > 120 beats/min with mechanism

›Earliest compensatory sign of hemorrhagic shock

›ECG tachycardia may precede hypotension by 15-30 minutes

›Lactate >= 2 mmol/l or base deficit <= -6

›Indicates significant hemorrhage and tissue hypoperfusion

›Serial lactate guides resuscitation adequacy

›Massive transfusion protocol activation threshold

›SBP < 90 with mechanism and clinical instability

›ABC score >= 2: penetrating mechanism, SBP <= 90, HR >= 120, FAST positive

Immediate stabilization sequence

›Primary survey actions

›Airway and breathing — standard ATLS primary survey

›Cervical spine precautions in high-energy mechanism

›Supplemental oxygen for SpO2 < 94%

›Pelvic binder placement at level of greater trochanters

›Use with caution in LC injuries — pelvis already internally rotated

›Over-tightening may worsen deformity in LC pattern

›Apply early if hemodynamically unstable regardless of subtype

›Two large-bore peripheral IV access or IO if IV not achievable

›16-gauge or larger

›Avoid lower extremity IV access in pelvic injury

›Activate massive transfusion protocol if hemodynamically unstable

›1:1:1 ratio pRBC:FFP:platelets or whole blood

02History/hx55

Mechanism and event

›High-energy mechanism

›T-bone motor vehicle collision (side impact)

›Most common cause of lateral compression injury

›Speed of impact, position in vehicle, seatbelt use

›Pedestrian struck by vehicle

›Direction of impact relevant to classification

›Motorcycle crash

›Fall from height with lateral landing

›Crush injury with body landing on lateral pelvis

›Extrication time and field vitals from paramedic report

›Low-energy mechanism in elderly

›Simple fall from standing height

›LC-I pattern common in fragility fractures

›Assess for precipitating cardiac or neurologic event

Symptoms and functional status

›Pain location

›Groin pain

›Lateral hip pain

›Sacral or buttock pain

›Posterior ring injury indicator

›Pain with log-roll or axial loading

›Functional impact

›Inability to ambulate or bear weight

›Key indicator of instability

›Leg-length discrepancy noticed by patient

›Suggests vertical instability (LC-III)

›Associated systemic symptoms

03Physical Exam/exam61

Vitals and hemodynamic assessment

›Hemodynamic snapshot

›Blood pressure

›SBP < 90 mmHg triggers hemorrhagic shock protocol

›MAP < 65 mmHg — vasopressor threshold

›Heart rate

›> 120 beats/min — significant hemorrhage indicator

›Persistent tachycardia despite resuscitation — ongoing bleeding

›Respiratory rate

›Tachypnea with abdominal splinting

›Elevated rate in significant pain or hemorrhage

›GCS and level of consciousness

›TBI is most common cause of death in LC fracture patients

›Altered sensorium may limit pain assessment reliability

Pelvic and musculoskeletal exam

›Inspection

›Pelvic asymmetry or deformity

›Limb-length discrepancy

›Suggests vertical instability

›Rotational deformity of lower extremity

›Internal rotation of hemipelvis in LC pattern

›Perineal or scrotal ecchymosis

›Vascular or urogenital injury

›Open wounds near perineum, groin, or buttock

›Open fracture indicator — mortality up to 50%

›Palpation

›Tenderness over pubic symphysis

›Tenderness over iliac crests

04Differential Diagnosis/ddx37

Life-threatening mimics and co-injuries

›Hip fracture (femoral neck or intertrochanteric)

›ICD-10: S72.001A-S72.145A

›Overlapping mechanism, especially in elderly

›AP pelvis and CT differentiate

›Key distinction: isolated hip fracture rarely causes hemodynamic instability

›Acetabular fracture

›ICD-10: S32.40-S32.49

›May coexist with pelvic ring injury

›CT with axial and coronal reconstructions defines extent

›Anterior-posterior compression (APC) pelvic fracture

›ICD-10: S32.811A-S32.819A

›Opens rather than compresses pelvis — higher hemorrhage risk

›AP pelvis shows symphysis diastasis

›Vertical shear pelvic fracture

›ICD-10: S32.811A

›Complete posterior ring disruption — highest instability

›Leg-length discrepancy, upward migration of hemipelvis

›Retroperitoneal hemorrhage from non-pelvic source

›Aortic injury

›Renal artery or parenchymal injury

›Hematuria with flank pain

›CT with IV contrast distinguishes source

Other differentials

›Hip dislocation

›ICD-10: S73.001A-S73.045A

›Obvious on AP pelvis — femoral head displaced

›Requires emergent reduction within 6 hours

05Laboratory Tests/lt45

Hemorrhage and resuscitation labs

›Complete blood count

›Serial hemoglobin monitoring

›Initial value may be normal despite significant hemorrhage (dilutional lag)

›Repeat every 4-6 hours or after transfusion

›Platelet count

›Massive transfusion target > 50 x 10^9/L

›Target > 100 x 10^9/L with ongoing bleeding or TBI

›Type and crossmatch

›Order early — anticipate transfusion needs

›Group and screen minimum in stable patients

›Full crossmatch in hemodynamically unstable patients

›Uncrossmatched O-negative pRBC if immediately life-threatening

›Coagulation panel

›PT/INR and aPTT

›Coagulopathy present in up to 25% of major trauma patients on arrival

›Target INR < 1.5 during active hemorrhage

›Fibrinogen

›Target > 1.5 mmol/l during active hemorrhage

›Cryoprecipitate if fibrinogen < 1.5 mmol/l

›Thromboelastography or ROTEM if available

›Goal-directed hemostatic resuscitation

›Identifies specific coagulation defects

Shock markers and metabolic labs

›Lactate

›Arterial or venous lactate

›>= 2 mmol/l indicates shock state

›>= 4 mmol/l indicates severe shock requiring aggressive resuscitation

06Diagnostic Tests/dt109

Scoring Systems

›Young-Burgess lateral compression classification

›LC-I: Ipsilateral pubic rami fractures + sacral compression fracture

›Rotationally stable pattern

›Most common pelvic fracture overall

›48% have complete sacral fractures on CT — heterogeneous group

›Overall mortality 8.2% in large series; mean ISS 17

›LC-II: Ipsilateral pubic rami fractures + crescent (iliac wing) fracture

›Rotationally unstable

›SI joint disruption may be partial

›Requires surgical fixation in most cases

›LC-III: Contralateral open book component (windswept pelvis)

›Ipsilateral LC-I or LC-II + contralateral SI joint disruption

›Rotationally and vertically unstable

›Highest mortality at 30 days (19%)

›Highest transfusion requirements

›Beckmann instability scoring system for LC-I fractures

›Validated radiographic score predicts occult instability

›Score < 7: stable — nonoperative management

›Score 7-9: indeterminate — consider stress radiographs

›Score > 9: unstable — surgical fixation recommended

›Correlates well with ED stress exam results

›Denis sacral fracture zone classification

›Zone I: Alar region — neurologic injury rate 6%

›Lateral to sacral foramina

›Zone II: Foraminal region — neurologic injury rate 28%

›Through sacral foramina

›Zone III: Central canal — neurologic injury rate 57%

›Most severe — bladder and bowel dysfunction

›ABC score for massive transfusion prediction

›Penetrating mechanism (1 point)

›SBP <= 90 mmHg (1 point)

›HR >= 120 beats/min (1 point)

›FAST positive (1 point)

›Score >= 2: activate massive transfusion protocol

›Sensitivity 75%, specificity 86% for massive transfusion need

MRI

›MRI pelvis indications

›Occult posterior ring fractures in elderly or fragility fractures

›Superior sensitivity when CT is negative but clinical suspicion remains

›Short-tau inversion recovery (STIR) sequence most sensitive

›Detects bone marrow edema at fracture site

›Neurologic deficit evaluation

›Sacral nerve root compression visualization

›Cauda equina injury assessment

›Soft tissue injury assessment

›Ligamentous disruption — posterior sacroiliac ligament integrity

›Muscle hematoma extent

›MRI limitations in acute setting

›Longer acquisition time — not for hemodynamically unstable patients

›CT preferred acutely

›Metal implants may limit quality

›Patient cooperation required — pain may limit positioning

›MRI performance characteristics

›Sensitivity for occult sacral fracture near 100% vs CT 50-68%

›Changes management in 30-40% of elderly patients with negative CT

›Protocol recommendation

›T1, T2, STIR sequences in axial and coronal planes

CT

›CT pelvis with IV contrast — gold standard

›Sensitivity 100% for bony pelvic ring fractures

›Defines sacral fracture morphology — complete vs incomplete

›Denis zone classification of sacral involvement

›Crescent fractures and iliac wing involvement

›Contrast extravasation — active arterial hemorrhage

›Blush on arterial phase — angioembolization candidate

›Extravasation volume correlates with hemorrhage severity

›Associated injury detection

›Intraabdominal solid organ injuries on same scan

›Retroperitoneal hematoma extent

›Bladder injury on cystogram phase

›Inlet and outlet reconstructions

›Inlet view: anterior-posterior displacement of posterior ring

›Outlet view: superior-inferior displacement

›CT angiography

›Indication: persistent hemodynamic instability or CT blush on standard scan

›LC injuries associated with anterior-division internal iliac artery injuries

›Identifies specific vessel for embolization

›Sensitivity approaching 100% for arterial hemorrhage source

›Initial AP pelvis radiograph

›Sensitivity limited at 50-68% for pelvic ring injury

›First-line screening in trauma bay before CT available

›Look for pubic rami fractures, sacral compression lines, pelvic asymmetry

›Do NOT remove pelvic binder for initial film

›Inlet-outlet views as adjuncts when patient stable

›Fluoroscopic ED stress radiographs

›Safe and reliable for LC-I minimally displaced fractures

›Performed in ED under fluoroscopic guidance

›Positive if >= 10 mm overlap of rami on stress views

›Negative stress predicts successful nonoperative treatment

›DeKeyser et al. 2022 — Class B evidence

Ultrasound

›FAST examination

›Rapid screening for intraabdominal free fluid

›Right upper quadrant — hepatorenal space

›Left upper quadrant — splenorenal space

›Subxiphoid — pericardial effusion

›Suprapubic — pelvic free fluid

›Performance in pelvic fracture context

›Pelvic hematoma may track anteriorly and mimic free fluid

›False negative rate up to 40% for retroperitoneal hematoma

›Sensitivity 60-70% for intraperitoneal hemorrhage requiring surgery

›FAST limitations

›Operator-dependent

›Cannot distinguish intraperitoneal from retroperitoneal blood on pelvic view

›Obesity and bowel gas reduce sensitivity

›Diagnostic peritoneal aspiration

›Alternative when FAST non-diagnostic in unstable patient

›Gross blood on aspiration — operative indication

›Reserved for ultrasound-limited scenarios

›Ultrasound-guided IV access

›Upper extremity peripheral IV in trauma bay

›Preferred over lower extremity access in pelvic injury

07Disposition/dispo41

Admission criteria

›ICU admission indications

›Hemodynamic instability requiring vasopressors

›Post-massive transfusion monitoring

›Ongoing hemorrhage concern

›Post-angioembolization monitoring

›Rebleed risk in first 24 hours

›Post-operative care

›External fixation or preperitoneal packing

›Associated TBI with GCS < 14

›Concurrent neurologic monitoring

›Respiratory failure or intubated patient

›Trauma/surgical ward admission

›LC-II and LC-III injuries — all require admission

›Orthopedic surgical planning

›LC-I with significant sacral displacement

›Positive stress exam or Beckmann score > 9

›Polytrauma with stable pelvic fracture

›Significant associated injuries

›Inability to ambulate safely

›Elderly patients on anticoagulation

›Fall risk, monitoring for neurologic change

Observation and monitoring

›ED observation appropriate for

›Stable LC-I with minimal displacement

›Pending orthopedic evaluation and stress testing

›Pain controlled with oral analgesia

›Normal hemodynamics and no associated injuries

08Treatment/t99

Damage control resuscitation

›Massive transfusion protocol

›Balanced resuscitation ratio 1:1:1 (pRBC:FFP:platelets)

›Targets trauma-induced coagulopathy prevention

›AAST/ACS 2024 clinical protocol recommendation

›Whole blood equivalent if available

›Tranexamic acid

›1 g IV bolus over 10 minutes

›Administer within 3 hours of injury

›CRASH-2 trial — reduces mortality in hemorrhagic trauma

›Second dose 1 g IV over 8 hours if hemostasis not achieved

›Calcium replacement during massive transfusion

›Calcium chloride 1 g IV per 4 units pRBC

›Prevents hypocalcemia from citrate in blood products

›Target ionized calcium > 1.1 mmol/l

›Avoid excessive crystalloid

›Contributes to dilutional coagulopathy

›Worsens hypothermia

›Permissive hypotension target SBP 80-90 mmHg until hemorrhage control

›Anticoagulant reversal

›Warfarin: Vitamin K 10 mg IV + 4-factor PCC (Kcentra)

›PCC 25-50 units/kg based on INR

›Do not wait for FFP alone in active bleeding

›Dabigatran: Idarucizumab (Praxbind) 5 g IV

›Rivaroxaban/apixaban: Andexanet alfa or 4-factor PCC 50 units/kg

›Target INR < 1.5 before surgical intervention

Pelvic stabilization

›Pelvic binder

›Applied at level of greater trochanters (NOT at iliac crests)

›Reduces pelvic volume and tamponades venous hemorrhage

›Use cautiously in LC — may increase internal rotation

›Sheetsling as alternative if commercial binder unavailable

›Do NOT remove for imaging — rescan with binder in place

›External fixation (damage control)

›Anterior external fixator for hemodynamic instability

›Reduces pelvic volume as bridge to definitive fixation

›Can be applied in OR or trauma bay

›Indication: ongoing instability after binder + resuscitation

›Preperitoneal pelvic packing

›Extraperitoneal approach to pelvic space

›Direct tamponade of venous hemorrhage

›FAST negative + hemodynamic instability pathway

›Combined with external fixation for maximal effect

›Reduces mortality in venous hemorrhage-dominant pelvic injury

›Angioembolization

›Indication: CT arterial blush or persistent instability after packing

›Targets anterior-division internal iliac artery branches

›Gel foam or coil embolization

›SIR position statement 2020: preferred modality for arterial pelvic hemorrhage

›Bilateral embolization acceptable if source not precisely identified

›Low risk of gluteal ischemia with modern technique

Analgesia

›Acute pain management

›Intravenous opioids first-line

›Morphine 0.1 mg/kg IV titrated to pain

›Fentanyl 1 mcg/kg IV for rapid onset

›Avoid NSAIDs acutely if hemorrhage concern

›Fascia iliaca compartment block

›Regional anesthesia adjunct

›Ultrasound-guided approach preferred

›Ropivacaine 0.5% 30-40 mL or bupivacaine 0.25% 30-40 mL

›Reduces opioid requirements by 40-60%

›Particularly effective for pubic rami and anterior ring fractures

›Acetaminophen 1 g IV every 6 hours as adjunct

›Opioid-sparing effect

›Hepatic dosing adjustment if liver injury coexists

Definitive fracture management

›LC-I management

›Nonoperative — weight-bearing as tolerated for minimally displaced

›Majority managed nonoperatively

›Negative stress exam predicts successful nonoperative outcome

›Surgical fixation indications

›Displacement >= 10 mm on stress exam

›Beckmann score > 9

›Complete sacral fracture with comminution

›Procedure: Percutaneous iliosacral screws ± pubic symphysis plating

›LC-II management

›Surgical fixation typically required

›Posterior ring fixation: iliosacral screws or posterior plating

›Anterior ring fixation: symphysis plate or pubic rami screws

›Timing: within 24 hours if hemodynamically stable

›LC-III management

›Surgical fixation of both anterior and posterior ring

›Damage control external fixation initially if unstable

›Definitive fixation delayed until after day 4 in polytrauma

›Highest complexity — specialized orthopedic trauma center

›Timing of definitive fixation

›Hemodynamically stable: within 24 hours

›Polytrauma or physiologically deranged: delay until after day 4

›Avoids lethal triad — hypothermia, acidosis, coagulopathy

›Hemodynamically unstable: damage control first

DVT prophylaxis

›Pharmacologic prophylaxis

›LMWH — pelvic fractures carry high VTE risk

›Enoxaparin 40 mg SC daily (or weight-based dosing)

›Start when hemorrhage risk adequately controlled

›Typically 24-48 hours post-operative or post-stabilization

›Unfractionated heparin 5000 units SC every 8-12 hours if renal impairment

›Mechanical prophylaxis

›Sequential compression devices to unaffected limbs

›Start immediately on admission

›IVC filter consideration if pharmacologic prophylaxis contraindicated

›High-grade spinal cord injury with complete paralysis

›Retrievable filter preferred

09Special Populations/sp82

Pregnancy

›Physiologic changes affecting assessment

›Supine hypotension syndrome

›Aortocaval compression by gravid uterus — left lateral tilt

›May mask true blood pressure deficit

›Physiologic anemia of pregnancy

›Baseline hemoglobin 100-120 g/L

›Lower threshold may still represent significant hemorrhage

›Increased blood volume (up to 50% above baseline)

›Maintains maternal perfusion at expense of uteroplacental flow

›Fetal distress may occur before maternal hemodynamic instability

›Fetal considerations

›Radiation exposure — CT cannot be withheld if maternal life at risk

›Single CT pelvis fetal dose approximately 25 mSv — acceptable in trauma

›Shield abdomen if feasible but do not delay imaging

›Obstetric consultation immediately

›Continuous fetal monitoring once maternal condition permits

›Cardiotocography for 4-24 hours post-trauma

›Placental abruption risk

›Vaginal bleeding, uterine tenderness, fetal heart rate abnormalities

›May occur without external abdominal trauma

›Uterine rupture — catastrophic

›Loss of uterine contour, fetal parts palpable abdominally

›Treatment modifications

›TXA safe in pregnancy — limited data but benefits outweigh risks in major hemorrhage

›Pelvic binder: apply with caution to avoid uterine compression

›Position at trochanters strictly

›Rh immunoglobulin (RhoGAM) for Rh-negative mothers after trauma

›300 mcg IM within 72 hours

Geriatric

›Epidemiology and mechanism

›LC-I fragility fracture pattern predominates in elderly

›Simple fall from standing height — same energy as hip fracture

›Osteoporotic bone fails under lateral compression

›Low-energy LC fractures represent 20-30% of all pelvic fractures in patients > 60

›Anterior precipitant — assess for cardiac event or neurologic cause of fall

›Physiologic considerations

›Blunted physiologic reserve

›HR may not rise above 100 despite significant hemorrhage (beta-blocker use)

›Baseline hypertension — SBP of 100 may represent significant hypotension

›Renal function decline

›Dose-adjust LMWH if CrCl < 30 mL/min

›Contrast nephropathy risk — pre-hydration if time allows

›Polypharmacy

›Anticoagulants and antiplatelets common — reversal critical

›Sedating medications worsen confusion and fall risk

›Fracture-specific considerations

›Occult sacral fractures common — CT sensitivity limited in osteoporotic bone

›MRI recommended if clinical suspicion despite negative CT

›STIR MRI changes management in 30-40% of elderly patients

›Higher rate of neurologic injury from sacral fractures in osteoporotic patterns

›Operative risk vs. benefit assessment

›Frailty scoring (CFS >= 5) predicts post-operative morbidity

›Disposition modification

›Lower threshold for admission — even stable LC-I

›Pain control, fall prevention, social support assessment

›Multidisciplinary team: orthopedics, geriatrics, physiotherapy

Pediatrics

›Epidemiology

›Pelvic fractures rare in children — elastic, cartilaginous pelvis more resistant

›High-energy mechanism required — pedestrian vs. vehicle, MVC

›LC pattern occurs but less common than in adults

›Associated injuries more common in pediatric pelvic fractures

›Abdominal organs less protected — liver, spleen, bladder

›Mortality predominantly from head injury in pediatric pelvic trauma

›Physiologic considerations

›Higher circulating blood volume per kg but smaller absolute volume

›80 mL/kg estimated blood volume

›20% loss (16 mL/kg) triggers significant shock physiology

›Faster physiologic compensation — tachycardia before hypotension

›HR > 160 in infant, > 140 in toddler, > 120 in child concerning

›SBP < 70 + (2 x age in years) mmHg — hypotension threshold

›Growth plates at risk — physeal injuries may affect future development

›Treatment modifications

›Weight-based resuscitation

›pRBC 10-15 mL/kg per transfusion

›FFP 10-15 mL/kg

›Platelet 10-15 mL/kg

›TXA 15-30 mg/kg IV (maximum 1 g) — evidence extrapolated from CRASH-2

›Pelvic binder sizing

›Commercial binders may not fit small children

›Sheet or towel sling as alternative

›LMWH prophylaxis

›Enoxaparin 0.5-1 mg/kg SC every 12 hours (weight-based)

›Start after hemorrhage control achieved

10Background/b80

Epidemiology

›Incidence and prevalence

›Pelvic ring fractures account for 3-8% of all fractures

›Bimodal distribution: young adults from high-energy trauma, elderly from fragility

›Lateral compression is the most common pelvic fracture pattern

›Approximately 60% of pelvic ring injuries

›LC-I most common subtype — sacral compression without instability

›LC-III (windswept pelvis) carries 30-day mortality of 19%

›Highest among all lateral compression subtypes

›Overall LC fracture mortality approximately 8.2% (Weaver et al.)

›Mean injury severity score 17

›Hemorrhage accounts for 40% of pelvic fracture mortality

›Venous plexus injury 80% of hemorrhage

›Arterial injury 20% but disproportionately severe

›Associated injury burden

›TBI present in 30-40% of high-energy LC fractures

›Most common cause of death

›Thoracic injuries common with LC mechanism

›Ipsilateral rib fractures, pneumothorax, pulmonary contusion

›Abdominal injuries: liver 6.1%, spleen, bladder 5.8%

›GU injury in 1.6-25% of pelvic fractures

›Neurologic injury from sacral fracture in 6-57% depending on Denis zone

›VTE incidence without prophylaxis up to 61% in major pelvic fractures

Pathophysiology

›Mechanism of injury

›Lateral force applied to greater trochanter or lateral ilium

›Internal rotation of hemipelvis on impact side

›Anterior ring buckles under compression — pubic rami fractures

›Posterior ring fails in impaction — sacral compression fracture

›LC-I: Sacral ala compresses and buckles (impaction fracture)

›Stable — posterior ligaments remain intact

›LC-II: Force greater — iliac wing fracture (crescent) or SI joint disruption

›Rotational instability — posterior ligaments partially disrupted

›LC-III: Contralateral force rotates opposite hemipelvis outward

›Anterior-posterior compression component contralateral side

›Bilateral posterior ring disruption — maximum instability

›Hemorrhage physiology

›Retroperitoneal space can accommodate up to 4 L of blood

›Tamponade effect may be lost with disruption of posterior ring

›Venous plexus injury — presacral and pudendal veins

›Responds to pelvic stabilization and packing

›Does not respond reliably to angioembolization alone

›Arterial injury — anterior-division internal iliac artery branches

›Superior gluteal, pudendal, obturator arteries

›Responds to angioembolization

›Neurologic injury mechanism

›Sacral nerve roots L4-S3 at risk from sacral fracture displacement

›Denis zone III (central canal) — cauda equina, bladder/bowel control

›Denis zone II (foraminal) — L5-S2, hip abductors, bladder

›Lumbosacral plexus stretching in LC-III (windswept pattern)

Therapeutic Considerations

›Evidence base for resuscitation

›CRASH-2 trial — TXA reduces hemorrhagic death by 1.5% when given within 3 hours

›No benefit beyond 3 hours — possible harm

›Standard of care for major trauma hemorrhage

›AAST/ACS 2024 damage control resuscitation protocol

›Balanced 1:1:1 transfusion evidence from PROPPR trial

›28-day mortality reduction with 1:1:1 vs. 1:1:2 ratio

›Angioembolization vs. preperitoneal packing

›Debate ongoing — institutional availability drives choice

›Packing superior for venous hemorrhage

›Angioembolization superior for arterial blush on CT

›Combination approach emerging in damage control algorithms

›Operative timing evidence

›Early definitive fixation (< 24 hours) in stable patients

›Reduces VTE risk

›Facilitates earlier mobilization

›Delayed fixation (> day 4) in polytrauma

›Avoids second-hit inflammatory response

›Damage control orthopaedics principle

›Stability assessment evidence

›ED fluoroscopic stress radiographs — DeKeyser et al. JBJS 2022

›Safe and reliable with no adverse events in prospective series

›Negative predictive value > 95% for nonoperative success

›Beckmann scoring — Dekeyser et al. JAAOS 2023

›Radiographic score correlates with stress exam outcome

›May identify stable patients who do not require stress exam

›Long-term outcomes

›Full functional recovery rates: LC-I 41%, LC-II 46%, LC-III only 11%

›Therrien et al. PLoS One 2025

›Chronic pain in 30-50% of LC fractures at 1 year

›Sexual dysfunction and urologic complications — LC-III highest rates

›Sacroiliac dysfunction — common long-term sequela

11Patient Discharge Instructions/pdi40

copy discharge instructions

›Pelvic fracture discharge instructions

›You have been diagnosed with a pelvic fracture from a lateral compression injury

›This means a bone in your pelvis was broken by a side impact force

›Most fractures of this type heal well with rest and activity modification

›Weight-bearing instructions

›Follow your orthopedic surgeon's specific instructions

›Most stable fractures allow weight-bearing as tolerated with crutches or walker

›Do not put full weight through your leg until cleared by your surgeon

›Activity restrictions

›Avoid driving until cleared by your surgeon (minimum 6 weeks)

›No heavy lifting or strenuous activity during healing phase

›Avoid climbing stairs without assistance initially

›Pain management

›Take prescribed pain medications as directed

›Acetaminophen 500-1000 mg every 6 hours as baseline

›Apply ice wrapped in cloth to the hip for 20 minutes at a time

›Avoid ibuprofen or naproxen unless specifically prescribed

›Bladder and bowel care

›Constipation is common — increase fluids and fiber

›Stool softeners if prescribed — take as directed

›Contact us if you are unable to urinate

›Blood clot prevention

›Take blood thinner medication as prescribed — do not skip doses

›Keep legs moving — ankle pumps and gentle leg exercises hourly

›Compression stockings if provided — wear as instructed

›Follow-up appointment

›Orthopedic surgery follow-up within 1-2 weeks

12References/r31

Guidelines and key sources

›Young-Burgess classification

›Young JW, Burgess AR, Brumback RJ, Poka A. Pelvic Fractures: Value of Plain Radiography in Early Assessment and Management. Radiology. 1986

›Foundational classification system for pelvic ring injuries

›Gao Y, Lou Z, Tang X. Rethinking LC-type in Young-Burgess Classification. Medicine. 2025. PMID 41029132

›Contemporary reassessment of LC subtype prevalence and outcomes

›Hemorrhage management

›LaGrone LN et al. AAST/ACS Clinical Protocol for Damage-Control Resuscitation. J Trauma Acute Care Surg. 2024

›Current standard for balanced resuscitation in trauma hemorrhage

›Coccolini F et al. Pelvic Trauma: WSES Classification and Guidelines. World J Emerg Surg. 2017. PMC5241998

›International guidelines for pelvic trauma management

›Anand T et al. Hemorrhage Control Interventions and Mortality in Pelvic Fractures. JAMA Surgery. 2023

›Angioembolization vs packing outcomes

›Puchwein P, Hallmann B, Eibinger N. Bleeding Management in Pelvic Trauma. Curr Opin Anaesthesiol. 2025. PMID 40071960

›Stability assessment

›DeKeyser GJ et al. Emergency Department Stress Radiographs of LC-1 Pelvic Ring Injuries. JBJS. 2022. PMID 34921551

›Prospective validation of ED stress exam safety and reliability

›Dekeyser GJ et al. Comparing ED Stress of LC-1 Pelvis Fractures With Beckmann Scoring. JAAOS. 2023. PMID 36727708

›Validation of radiographic instability scoring system

›Ellis JD et al. Anterior Pelvic Ring Fracture Pattern Predicts Displacement in LC Sacral Fractures. J Orthop Trauma. 2022. PMID 35583370

›Epidemiology and outcomes

›Weaver MJ et al. Patterns of Injury in Lateral Compression Pelvic Fractures. Clin Orthop Relat Res. 2012. PMID 22585347

›Manson T et al. Young-Burgess Classification: Mortality, Transfusion, Non-Orthopaedic Injuries. J Orthop Trauma. 2010. PMID 20871246

›Therrien CC et al. Functional Status and HRQoL Following Young-Burgess Pelvic Ring Injuries. PloS One. 2025. PMID 41955237

›Long-term functional outcomes by LC subtype

›Khurana B et al. Pelvic Ring Fractures: What the Orthopaedic Surgeon Wants to Know. Radiographics. 2014. PMID 25208283

›Demetriades D et al. Pelvic Fractures: Epidemiology and Associated Injuries. J Am Coll Surg. 2002. PMID 12113532

›Imaging

Evidence & Review