Investigations for Stable Pelvic Fracture Patients

Primary Imaging Investigation

The World Journal of Emergency Surgery recommends that for hemodynamically stable patients with pelvic fractures, a multi-phasic CT scan with intravenous contrast should be performed, omitting the need for a pelvic X-ray in this population 1, 2
Multi-phasic CT scan with IV contrast is the gold standard for stable pelvic fracture patients, with 100% sensitivity and specificity for bone fractures 1, 3
The CT protocol should include arterial, portal, and delayed phases to optimally evaluate for hemorrhage or hematoma 4, 3
CT with 3-dimensional bone reconstructions should be obtained to reduce tissue damage during subsequent procedures, decrease operative time, and improve surgical planning 1, 5, 2

Essential blood work includes serum lactate and base deficit, which are the most sensitive markers for estimating traumatic-hemorrhagic shock extent and monitoring resuscitation response 1, 5, 2
Point-of-care coagulation testing using Thromboelastography (TEG) or Rotational Thromboelastometry (ROTEM) is recommended for early coagulopathy detection, allowing targeted blood product resuscitation 5, 2

Retrograde urethrogram and/or urethrocystogram with contrast CT is recommended when there is perineal hematoma or pelvic disruption on imaging 1, 5, 2
Perineal and rectal digital examination are mandatory when rectal injury is suspected, and proctoscopy is recommended if rectal examination is positive 1, 5, 2

Contrast extravasation has 98% accuracy for identifying arterial bleeding, though absence doesn't exclude active bleeding 4, 3
Pelvic hematoma size ≥500 cm³ strongly suggests arterial injury even without visible contrast blush 4, 3

Pelvic X-ray should be omitted in hemodynamically stable patients without pelvic instability, hip dislocation, or positive physical examination who are scheduled for CT scan 4, 3
The sensitivity of pelvic X-ray is only 50-68% with false negative rates of 32%, making it inadequate as definitive imaging in stable patients 5, 4, 3

Do not rely on hemoglobin/hematocrit as early indicators of blood loss—they lag behind actual hemorrhage 5, 2
Elderly patients warrant special consideration, and may require angiography regardless of hemodynamic status, even with mechanically stable low-risk fractures 6