Classification of pelvis injuries includes lateral compression, anterior/posterior compression, vertical shear and a combination of lateral compression and vertical shear. Most patients having pelvic fractures are victims of high-energy accidents and should have diagnostic workups as suggested by guidelines from the American College of Surgeons. After immobilization in the field, the patient undergoes evaluation in an Emergency Depart-ment with attention to the ABC’s of trauma care. Simultaneously, baseline vital signs and neurologic status are noted. General status of the pelvis should be assessed by palpation, inspection and detailed neurological and vascular examinations. At our hospitals in Springfield, preliminary radiographic assessment is performed with an AP pelvis X-ray. Inlet and outlet views are usually performed at our hospitals to assess the pelvic ring as well as anterior and posterior displacement, degree of rotational displacement and to assess the sacroiliac joint. Obturator and iliac oblique views further delineate fractures of the acetabulum. Computer tomography is extremely important to help delineate injuries to the posterior ring as well as imaging of acetabular pathology. Associated pathological conditions of pelvis injuries include hemorrhage, genito-urinary injury, gastrointestinal injury and open pelvic fractures. The first therapeutic approach to a patient with hypotension secondary to a pelvic fracture is to identify its etiology. Hypotension in an injured patient is most likely due to hypovolemia, caused by hemorrhage. Four potential sites of bleeding include the chest, peritoneal cavity, long bones and the extra peritoneal space of the pelvis. Hemorrhage is the most perilous complication associated with pelvic fractures. It may result from bleeding of the fracture, venous or arterial tears or disruption of a major vessel. There are many methods of treating hemorrhage associated with pelvic fractures. A simple safe temporary technique includes a bed sheet wrapped around the pelvis and twisted to apply compression, thereby preserving life due to the pelvic ring bleeding. External fixation, internal fixation, embolic angiography and laparotomy also can be considered.

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