Injuries of the Pelvis Goals of Treatment One of the initial goals in the treatment of pelvic fractures is the rapid identification and management of any ongoing bleeding associated with pelvic fractures or other concurrent injuries Life-threatening hemorrhage from pelvic fractures is unusual, but if present, must be identified with timely treatment and resuscitation CLINICAL PEARLS AND PITFALLS The presence of bilateral anterior and posterior fractures is associated with the greatest risk of hemorrhage and intra-abdominal injury Isolated pubic ramus fractures have the lowest risk for these In the setting of concern for pelvic fracture, a patient with blood at the urethral meatus should be evaluated for injury to the genitourinary structures In the absence of abnormalities on physical examination of the pelvis, lower extremity fracture, or other indication for abdominopelvic CT, the risk of pediatric pelvic fracture is low Current Evidence Pelvic fractures are typically caused by high-energy mechanisms of injury that can be associated with multisystem trauma, including to the head, abdomen, genitourinary (e.g., urethra), and vascular structures There should be a high index of suspicion for potentially life-threatening soft tissue or vascular injury The role of routine screening pelvic x-rays in the setting of trauma has been questioned In the conscious patient with a normal pelvis and lower extremity examination, routine x-rays of the pelvis may not be indicated, as the physical examination has a high specificity and negative predictive value for pelvic fractures, but only moderate sensitivity Furthermore, if a patient with multisystem trauma undergoes an abdominal–pelvic CT scan for evaluation, screening radiographs are not necessary as the sensitivity of CT for detecting pelvic fractures is higher than pelvic radiographs Clinical Considerations Clinical recognition The pediatric pelvis has greater elasticity of the sacroiliac joint and the symphysis and more plasticity of the pelvic bones than the adult pelvis As a result, a higher-energy impact is required to cause a fracture