Emergency Department Clinical Pathway for Evaluation/Treatment
of Children with Suspected Pelvic Fracture

Transfer from Outside Hospital
> 15 years, contact:
Trauma and Orthopedics for acceptance
Orthopedics Attending consults
Penn Presbyterian about transfer
Acute Complications
  • Most often from associated injuries
  • Hemorrhagic shock
  • Neurovascular injury
  • Infection
Long-term Complications
  • Leg length discrepancy
  • Gait disturbance
  • Chronic low back pain
  • Acetabular fractures
    • Growth disturbance
    • Arthritis
Urology Consult
  • Blood in urine
  • Blood meatus, vagina
  • Perineal, penile hematoma
  • Fx pubic ramus, symphyseal diastasis
  • X-ray suggestive of bladder neck injury
  • Unable to void
IR Consult
  • Pelvic fracture with hemodynamic instability that is unresponsive to a pelvic binder
ID Consult
  • Open pelvic fracture
Patients ≥ 15 years, Transport Request
  • Refer call to Orthopedics on-call
ATLS Survey
  • Hemodynamic Stability
  • Pain Management
ED Trauma Order Set
  • Trauma Labs
  • X-rays including AP Pelvis
Consults
  • Trauma
  • Orthopedics
  • Consider Urology
  • Consider IR if hemodynamic concerns
Additional imaging studies as clinically indicated by Trauma team
Stable
Hemodynamics
Avulsion or Iliac Wing Fracture
ED Treatment, Discharge Home
Ortho Follow-up, 1 week
Stable Pelvis Ring Fracture
Admit Floor, Trauma Service
PT Consult
Weight Bearing Pelvic Films, after PT consult
PICU as indicated
Possible Unstable Fracture
Admit PICU, Trauma Service
Pelvis CT, no contrast, with 3D reconstructions Consider exam under anesthesia
 
Unstable
Hemodynamics
Fluid resuscitation
Packed RBCs as indicated
Assess other causes of bleeding
Patient
Stabilizes
Patient Remains
Unstable
Stable Fracture
CTA with IV contrast
Use Sheets in a Kocher
CTA with IV contrast
Stable Fracture
CTA with IV contrast
Use Sheets in a Kocher CTA with IV contrast
Consider IR Consultation for possible embolization
Admit PICU
Trauma Service
Transfer from Outside Hospital
> 15 years, contact:
Trauma and Orthopedics for acceptance
Orthopedics Attending consults
Penn Presbyterian about transfer
Posted: April 2018
Revised: November 2022
Authors: K. Baldwin, MD; J. Lavelle, MD; J. Callahan, MD; T. Metjian, PharmD; V. Ho Fung, MD; D. Perks, CRNP