The human pelvis is incredibly strong, extreme forces are required to damage it. In an urban environment, the forces are typically generated by motor vehicle accidents, in the wilderness, by falls; any large traumatic MOI is suspect. Wounds over the pelvis or bleeding from the patient's rectum, vagina or urethra may indicate an open pelvic fracture. The presence of pain in the pelvic area, including the lower back near the sacroiliac joint, groin, and hips combined with a large traumatic MOI indicates a potentially unstable pelvis.
- BIG traumatic MOI.
- Pain in the pelvic area, including the lower back near the sacroiliac joint, groin, and hips.
- ± instability, ± S/Sx of volume shock, ± blood in urine (red/brown), ± bladder/bowel incontinence.
- Up to 40% of pelvic fracture patients have abdominal injuries.
Prehospital field treatment of pelvic fractures requires improvising a pelvic splint using a folded tarp (shown below), tent footprint, sleeping pad, clothing, etc. The splint may need to stay on for 24 plus hours; the material chosen should soft and comfortable to help avoid pressure ulcers. Lift patient and center a the splint over the femoral trochanters and pubis. Gently pull to tighten, maintain tension, and secure using horse-blanket pins; if pins are not available, use duct tape, or tie a secure knot. Move the pelvis as little as possible; avoid rolling patient.