Evaluation

How will my fracture be evaluated?

At the scene of the accident the focus is often on resuscitating a multiply injured patient, treating shock, and transporting the patient to hospital as soon as possible. Clinical diagnosis of a fractured pelvis is difficult although it is easy to suspect this injury. In the case of an elderly person who has sustained a fall the situation can be confused with a hip fracture - warming the patient, treating shock, splinting, and rapid transfer to hospital are appropriate in both cases.

In the Emergency Room the focus of the treating team is on resuscitating the patient, making sure all the injuries are identified and the appropriate specialists are consulted. The clothes will need to be removed to allow examination of the pelvic area and this may necessitate cutting off some clothing. The site of the injury will be carefully felt for tenderness and examined for wounds, swelling, bruising, or blood at the urethra. Pain from movement of the limbs will also be evaluated and related to the sites of injury. The general medical status will be evaluated, especially in the case of elderly patients or patients with multiple injuries.

It is very common for the bladder to be catheterized to monitor kidney function when blood loss is suspected. Sometimes it is difficult to pass a catheter and this would suggest an injury to the urethra or bladder. In shocked or multiply injured patients the trauma team may be called in. The focus of this team is diagnosis and management of life-threatening parts of the injury which might include a pelvic fracture with massive blood loss.

The x-rays ordered by the Emergency Room doctors will likely include a plain x-ray of the pelvis with views of the hip if there seems to be pain on moving it. In the case of multiple injuries and especially if there is shock from blood loss, it is common practice to obtain a computerized tomography (CT) scan of the chest and abdomen including the pelvis. If the plain x-rays or CT scans show a fracture of the pelvis an orthopaedic consultation would be requested. The orthopaedic specialist may be part of the trauma team or may be called in by the ER doctor or the Trauma Team. Usually some preliminary evaluation has been done by this time and the pelvic fracture has been demonstrated by x-ray or CT scan.

The orthopaedic surgeon will ask about the patient's symptoms and examine the pelvic area and limbs paying particular attention to sites of tenderness and any areas or numbness, swelling, or bruising. The x-rays will be evaluated and further views or computerized tomography (CT) scans may be taken to make sure the extent of the injury is understood and documented. The orthopaedic surgeon will come to a conclusion about the type of injury that has been sustained and discuss the management options with the patient, the rest of the treating team and the family. This discussion will include consideration of the patient's life-style, sports and work activities, general medical status and expectations in addition to the fracture itself. The management options might include transfer of the patient to a trauma center, non-operative management or surgery. If surgery for other injuries (for example a ruptured bladder) is required this may also affect the orthopaedic plan.