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.