Pelvic and Thigh Injuries

Unstable pelvic fractures

  • Often associated with other injuries. ED senior should have been called
  • IV infusion x 2: blood for FBC, X-match, clotting and U&E.
  • Analgesia
  • Catheterise only if no evidence of rupture of urethra (blood at end of penis, bruising of penis, and perineal bruising, high prostate on PR), if not straight forward, abort.
  • Do not inflate balloon until urine is seen.
  • Examine urine for blood.
  • Ask advice about exclusion of abdominal/urinary tract injury
  • Bind pelvis with a sheet/pelvic binder to reduce bleeding. Do not pull too tight. Pelvic binders are only useful with open book fractures.
  • Discuss with Orthopaedic Registrar urgently

Unilateral fracture superior and/or inferior pubic ramus

This is a stable injury, and needs symptomatic treatment only. If patient can walk - can go home for initial bed rest and analgesia, followed by mobilisation. May benefit from stick, walking frame etc. GP follow up. If can’t walk, D/W medical team for admission.

Central dislocation of hip.

  • IV infusion, blood for FBC, cross matching, U&E's
  • Refer orthopaedics

Posterior dislocation of hip/fracture dislocation.

  • Test sciatic nerve
  • Analgesia. Ask senior advice re relocation under sedation.
  • Refer orthopaedics

Avulsion fractures (e.g. from ant. inf. iliac spine)                                                                                         

  • Symptomatic treatment e.g. analgesics, walking stick or crutches.
  • Some may need admission
  • Refer next Fracture Clinic

Fracture neck of femur                   

  • Outrule acute medical cause for collapse
  • Analgesia. Discuss with Registrar/Consultant re regional nerve block.
  • CXR in elderly
  • Refer orthopaedics
  • See separate protocol


Fracture greater trochanter            
Management as for fracture pubic ramus.

Fracture shaft femur                       

  • IV infusion, blood for FBC and cross-matching at least 2 units in adults.
  • Analgesia. Consider femoral nerve block (ask advice)
  • Femoral traction splint (before X-ray)
  • Ensure x-ray includes hip joint
  • Refer orthopaedics

Quadriceps haematoma                   

  • Advise ice packs/elevation at home
  • Crutches
  • Analgesia
  • Review Clinic in one week.