Initial management and classification of pelvic fractures.

Pelvic fractures represent a significant transfer of kinetic energy to the body, and more than 80% of patients with unstable pelvic fractures have additional musculoskeletal injuries. A systematic approach with prompt intervention is critical in the initial management of patients with pelvic fractures. If intra-abdominal bleeding is suspected, diagnostic peritoneal lavage, focused assessment with sonography for trauma, or a CT examination is usually performed. CT angiography and interventional radiographic angiography are useful tools for determining the location of bleeding and the amount of blood loss. Patients presenting in extremis should undergo immediate pelvic stabilization and laparotomy with pelvic packing if indicated. Stable patients can undergo CT angiography. If a large pelvic hematoma or contrast blush is present, extraperitoneal packing or angiography can be performed based on the availability of the needed subspecialists. The orthopaedic surgeon provides prompt stabilization using external immobilizers, external fixation, or traction. The bladder, urethra, and nerve roots have an intimate location within the pelvis and are predisposed to injury in patients with pelvic fractures. Appropriately identifying associated abdominal, urologic, or neurologic injuries will provide important opportunities to reduce patient morbidity and improve long-term outcomes.