When people have been in a major accident are taken to an emergency department, serious injuries must be treated as soon as possible. If bleeding is severe, steps must be taken immediately to stop the bleeding. People usually need to be admitted to a hospital.
Minor, stable pelvic fractures typically heal without causing permanent disabilities. Surgery is rarely needed, but bed rest may be needed. However, bed rest should be for as short a time as possible. Pain relievers (analgesics) can help relieve pain enough so that people can walk. To avoid the weakness, stiffness, and other complications that occur with bed rest, people should walk, stand, and put their full weight on the joint as soon as possible, even if they can do so only for a short time. Trying to walk does not injure the area further. Most people can walk short distances without a walker by 1 week and can walk without aid and with only mild discomfort in 1 to 2 months.
Severe pelvic fractures, which are often unstable, must be immobilized. Emergency personnel usually stabilize the joint by wrapping it with strips of cloth or with a binder designed for this purpose until the injury can be more permanently stabilized. To more securely stabilize the injury, especially if there are other serious injuries, doctors may attach a rigid metal frame to the pelvis, outside the body, using long screws inserted through the skin into the bones. This device is called an external fixator. Once the injury is more stable, surgery is usually done to align the broken pieces of bone and to insert plates and screws to hold them in place (called open reduction with internal fixation, or ORIF). After the pelvis is stabilized, people are encouraged to walk as soon as possible. Sometimes the fracture is surgically repaired immediately, without use of an external fixator.
If bleeding continues, embolization or pelvic packing may be done:
Embolization involves inserting a thin, flexible tube (catheter) into a blood vessel and threading it to the injured blood vessel. Tiny coils or a gel-like substance is inserted through the catheter into the bleeding blood vessels to block them and thus stop the bleeding.
Pelvic packing involves surgery to insert material around the damaged organs in the pelvis. This material absorbs the blood and puts pressure on blood vessels, which helps slow or stop the bleeding. Once the bleeding has stopped, usually days later, surgery is done to remove the packing and the pelvis is repaired surgically (ORIF).
Other injuries are treated as needed.