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Blunt pelvic trauma

The most common causes of blunt pelvic trauma are motor vehicle crashes and multiple-story falls, and thus pelvic injuries are commonly associated with additional traumatic injuries in other locations. In the pelvis specifically, the structures at risk include the pelvic bones, the proximal femur, major blood vessels such as the iliac arteries, the urinary tract, reproductive organs, and the rectum.

One of the primary concerns is the risk of pelvic fracture, which itself is associated with a myriad of complications including bleeding, damage to the urethra and bladder, and nerve damage. If pelvic trauma is suspected, emergency medical services personnel may place a pelvic binder on patients to stabilize the patient's pelvis and prevent further damage to these structures while patients are transported to a hospital. During the evaluation of trauma patients in an emergency department, the stability of the pelvis is typically assessed by the healthcare provider to determine whether a fracture may have occurred. Providers may then decide to order imaging such as an X-ray or CT scan to detect fractures; however, if there is concern for life-threatening bleeding, patients should receive an X-ray of the pelvis. Following initial treatment of the patient, fractures may need to be treated surgically if significant, while some minor fractures may heal without requiring surgery.

A life-threatening concern is hemorrhage, which may result from damage to the aorta, iliac arteries, or veins in the pelvis. The majority of bleeding due to pelvic trauma is due to injury to the veins. Fluid (often blood) may be detected in the pelvis via ultrasound during the FAST scan that is often performed following traumatic injuries. Should a patient appear hemodynamically unstable in the absence of obvious blood on the FAST scan, there may be concern for bleeding into the retroperitoneal space, known as retroperitoneal hematoma. Stopping the bleeding may require endovascular intervention or surgery, depending on the location and severity.