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Pelvic trauma: Initial evaluation and management

James Fiechtl, MD
Section Editors
Maria E Moreira, MD
Richard G Bachur, MD
Deputy Editor
Jonathan Grayzel, MD, FAAEM


Pelvis injuries range from the benign to life threatening. They include pelvic ring fractures, acetabular fractures, and avulsion injuries. The majority of pelvis injuries are due to high energy blunt trauma, although frail and elderly patients may sustain such injuries from a low energy mechanism (ie, fall). High energy trauma increases the likelihood of concomitant injuries, likely involving the abdominal and pelvic viscera.

Bony pelvic injuries in adults will be reviewed here. Abdominal injuries and other aspects of trauma, including initial management, are discussed separately. (See "Initial evaluation and management of blunt abdominal trauma in adults" and "Initial management of trauma in adults".)


Incidence and mortality — Pelvic fractures represent approximately 3 percent of skeletal injuries [1]. Overall mortality from pelvic fractures ranges from 5 to 16 percent, with the rate for unstable pelvic fractures approximately 8 percent [2,3]. Patients with pelvic fractures who are in shock at presentation have high mortality [4]. The mortality rate associated with acetabular fractures is 3 percent [5], while open pelvic fractures, which comprise 2 to 4 percent of all pelvic fractures, are associated with a mortality rate of up to 45 percent [1,2,6-8]. Most fatalities stem from associated internal injuries; deaths attributed solely to pelvic fractures range from 0.4 to 0.8 percent of trauma fatalities [3,7,9]. Patients aged greater than 65 with pelvic fractures have a mortality rate of approximately 20 percent [10]. Overall, pelvic fractures are associated with an increased risk of death among trauma patients [11,12].

An Australian study of pelvic ring fractures demonstrated an incidence of 23 per 100,000 persons per year, while a British study found the incidence of acetabular fractures to be 3 per 100,000 persons per year [13,14]. Reviews of two large trauma registries found the incidence of pelvic ring fractures among admitted trauma patients to be 8 and 9.3 percent, respectively [9,15].

Risk factors for pelvic fractures include low bone mass, smoking, hysterectomy, older age, and a propensity to fall [16]. Age greater than 60 years in patients with significant pelvic fractures predicts a higher likelihood of bleeding requiring angiography [17,18].

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Literature review current through: Nov 2017. | This topic last updated: Jan 19, 2017.
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