treatment

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Emergency treatment is essentially ATLS management. There may be severe hypovolaemic shock due to retro or intra-peritoneal haemorrhage and a diagnostic peritoneal lavage may be necessary to exclude intra-abdominal bleeding. A suprapubic - not urethral - catheter should be passed if there is evidence of membranous urethral injury - such as blood at the meatus and a high riding prostate. Not not passing urine is usually due to shock.

Definitive treatment:

  • With displaced fractures without sacroiliac disruption - If there is disruption of the symphysis pubis the patient can be nursed in a canvas sling for 6 to 8 weeks. For more severe injuries or injuries with severe soft tissue damage external fixation is used. If the pubic rami are fractured, as may occur with lateral compression one would prescribe bed rest with leg traction for 3-4 weeks or external fixation if there is severe displacement.

  • With displaced fractures with posterior disruption - as occurs with all vertical shear injuries and the more severe compression injuries. The fracture must be reduced and stabilised either with internal fixation (plates and screws) or external fixation combined with bed rest and traction for 8-12 weeks.

Last reviewed 01/2018