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An Evidence-Based Approach To Managing Injuries Of The Pelvis And Hip In The Emergency Department

Injuries to the pelvis and hip are wide-ranging, from benign to life-threatening. The life-threatening injuries predominantly involve disruption of the pelvic ring. Although hip injuries that are localized to the acetabulum and proximal femur and avulsion injuries can be severe and cause significant morbidity, they are generally not life-threatening...

High-energy injuries to the pelvis and hip have a fairly straightforward differential diagnosis, which includes fracture, dislocation, ligamentous injury, or referred pain from an intraabdominal injury. Lowenergy or atraumatic injuries have a much broader differential, including the aforementioned diagnoses as well as the following:…

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 Can’t Miss Adult Traumatic Hip and Pelvis Injuries

This list is not meant to be a comprehensive review of each body part, but rather to highlight and improve your sensitivity for these potentially catastrophic injuries.

Articles of Interest

Acetabular Fractures

The majority of acetabular fractures are caused by some type of high-energy event, such as a car collision. Many times patients will have additional injuries that require immediate treatment. In a smaller number of cases, a low-energy incident, such as a fall from standing, may cause an acetabular fracture in an older person who has weaker bones. Treatment for acetabular fractures often involves surgery to restore the normal anatomy of the hip and stabilize the hip joint.

Back to Basics: Pelvic XRays

Because the pelvis is a ring-like structure, be wary that a fracture in one part of the ring is often accompanied by damage to bone, ligament or tendon structures at some other point in the structure. Usually low-energy fractures have only one break in the ring, and there is usually maintained alignment of the broken ends. In this case, there is low likelihood of the bones dislocating abruptly and causing damage to underlying structures, in which case these are considered stable pelvic fractures. These fractures can usually be managed non-operatively.

Hip and Pelvis Injuries

This review cover a lot of territory and is well worth reading for its comprehensive yet lucid overview of traumatic injuries to the pelvis and hip. The review’s selection of clinical and educational images alone makes it worth the effort. The following Q-and-A pearls are only the merest glimpse of what this paper contains in its 24 pages.

Pelvic Injuries

Pelvic fractures constitute 1-3% of pelvic skeletal fractures. In younger adults, a pelvic fracture is generally due to high energy pelvic injuries secondary to motor vehicle injuries, pedestrian injuries, falls from height, motorcycle accidents and crush injuries. In the elderly, it may occur following a fall from a sitting position. Pelvic trauma-related mortality is between 3-20%. It reaches 40-50% in hemodynamically unstable patients.

Radiologic Approach to the Traumatic Hip/Pelvis

Why the hip matters and the radiology rule of 2’s.