Suspected Pelvic Fractures: A Guide for Advanced First Aiders
/
Pelvic fractures are potentially life-threatening injuries that require prompt recognition and careful management in the field. While not as common as limb fractures, they can result in significant internal bleeding, organ injury, and long-term disability. For advanced first aiders, understanding the mechanisms of injury (MOIs), assessment priorities, and prehospital management strategies is critical to improving patient outcomes.
Understanding Pelvic Fractures
The pelvis is a ring-shaped bony structure that supports the spine and houses major organs, blood vessels, and nerves. Fractures can range from minor, stable cracks to severe, unstable disruptions. Because of the pelvis's proximity to major vessels, even a closed fracture can result in life-threatening hemorrhage.
Key Points for AFAs:
Pelvic fractures are high-risk injuries, often associated with significant trauma.
Internal bleeding may not be immediately visible but can lead to shock.
Early recognition and proper immobilization can save lives.
Common Mechanisms of Injury (MOIs)
Advanced first aiders should be aware of the circumstances that often lead to pelvic fractures. These include:
Motor Vehicle Collisions (MVCs)
Frontal, side, or rollover impacts can transmit high forces to the pelvis.
Pedestrians struck by vehicles are particularly susceptible.
Falls from Height
Falling from a significant height (e.g., ladders, scaffolding, or buildings) can result in vertical compression injuries.
Landing on feet or buttocks can drive force into the pelvic ring.
Crush Injuries
Heavy objects falling on the pelvis or entrapment in machinery can cause unstable fractures.
Often associated with other musculoskeletal and internal injuries.
Sports and High-Impact Activities
Extreme sports, skiing, horseback riding, or cycling accidents can occasionally result in pelvic trauma.
Industrial or Workplace Accidents
Falls, heavy machinery accidents, or scaffolding collapses are common MOIs in occupational settings.
Recognizing Pelvic Fractures
Symptoms may include:
Severe pain in the hip, groin, or lower back
Inability to bear weight or move legs
Swelling, bruising, or deformity in the pelvic area
Shortened or externally rotated leg (in cases of hip involvement)
Signs of shock (pale, clammy skin, rapid pulse, hypotension)
Red Flags for AFAs:
Hemodynamic instability (low blood pressure, rapid heart rate)
Abdominal or perineal bruising
Blood at the urethral meatus
Unexplained hypotension following trauma
Field Assessment
Advanced first aiders should prioritize scene safety, mechanism awareness, and rapid assessment:
Scene Size-Up:
Ensure the environment is safe.
Consider high-energy trauma scenarios where pelvic injury is likely.
Primary Survey (ABCs):
Assess airway, breathing, and circulation immediately.
Treat life-threatening conditions first.
Pelvic Assessment:
Avoid direct manipulation or "pushing" on the pelvis. This can worsen bleeding.
Look for external signs of injury: bruising, swelling, deformity.
Check for associated injuries (spinal, femoral, abdominal).
Pelvic Immobilization: Correct Application of a Pelvic Binder
Pelvic fractures can cause life-threatening internal bleeding. Stabilizing the pelvis with a pelvic binder is one of the most important interventions you can perform in the field. Proper placement is critical—incorrect positioning can worsen bleeding or fail to stabilize the fracture.
Why Immobilization Matters
Reduces movement of the fractured pelvic ring, minimizing further tissue and vessel damage.
Helps control internal hemorrhage by reducing pelvic volume and tamponading bleeding vessels.
Provides pain relief and prevents further injury during transport.
Step-by-Step Application of Pelvic Binding
1. Preparation:
Assess the patient and confirm suspected pelvic fracture.
If available, use a commercial pelvic binder (e.g., T-Pod). If not, an improvised binder (e.g., folded sheet) can be used.
Ensure the patient is supine on a firm surface before applying the binder.
2. Correct Positioning:
Placement should be over the bony prominences of the iliac crests..
Improper placement can fail to stabilize the pelvic ring.
The binder should wrap firmly around the pelvis, encircling the pelvis snugly.
3. Application:
Slide the binder under the patient if using a sheet or sling.
Center the binder over the iliac crests on both sides.
Tighten evenly to compress the pelvis.
4. After Application:
Reassess distal circulation and lower limb alignment.
Monitor for signs of worsening pain, numbness, or compromised circulation.
Keep the patient immobilized and transfer carefully to EMS.
Key Points for Advanced First Aiders:
Always assume high-energy trauma could involve a pelvic fracture, even if external signs are minimal.
Never manipulate or “palpate” the pelvis excessively; use stabilization devices instead.
Reassess hemodynamics continuously; immobilization helps but does not replace urgent transport and shock management.
Associated Complications
Advanced first aiders must monitor for:
Hemorrhagic shock – the leading cause of death in unstable pelvic fractures.
Urogenital injuries – bladder or urethral trauma may be present.
Neurological compromise – nerve injuries affecting lower limbs.
Long-term mobility issues – delayed or improper treatment can lead to chronic pain or gait abnormalities.
Key Takeaways for Advanced First Aiders
High-energy trauma or certain MOIs should raise suspicion of pelvic fractures.
Avoid unnecessary movement of the pelvis; stabilize with a binder.
Monitor for shock and provide supportive care.
Rapid assessment and transport save lives.
Communication with EMS and the receiving hospital is critical.
Conclusion:
Pelvic fractures are high-risk injuries with potentially life-threatening complications. For advanced first aiders, recognizing high-risk MOIs, performing a careful assessment, stabilizing the patient, and preparing for rapid transport are essential steps in the chain of survival. By understanding the complexities of pelvic trauma in the field, AFAs can play a vital role in improving patient outcomes.
