Hip iSAWE 14

Question

A 40 year old motorcyclist is hypotensive in the emergency department after a high speed crash.

Hip iSAWE 14, AP radiograph of the pelvis
AP radiograph of the pelvis. Image by Nevit Dilmen (talk), Wikimedia Commons, CC BY-SA 3.0.
  1. Describe the radiograph and classify the injury.
  2. Outline your initial management of the haemodynamically unstable patient.
  3. What is the definitive management?

Answer

Radiograph

  • Symphysis pubis diastasis
  • Anteroposterior compression injury
  • Over 2.5 cm diastasis implies sacrospinous and anterior sacroiliac ligament injury (APC II)

Young and Burgess APC types

TypeFeatures
APC ISymphysis under 2.5 cm, posterior ligaments intact
APC IISymphysis over 2.5 cm, anterior SI ligaments torn, posterior intact
APC IIIComplete SI disruption, vertically stable, highest transfusion need

Initial management

  • ATLS, massive transfusion protocol and tranexamic acid
  • Pelvic binder at the level of the greater trochanters
  • Exclude other sources of bleeding with FAST or CT
  • Venous bleeding most common, arterial in about 15%
  • Preperitoneal packing or angioembolisation for ongoing bleeding
  • Anterior external fixator as temporary stabilisation
  • Examine perineum, rectum and vagina for open injury, check for urethral injury before catheterisation

Definitive

  • Symphyseal plating through a Pfannenstiel approach
  • Iliosacral screws for posterior SI disruption in APC III
  • Thromboprophylaxis

Related pages

Author Contributions

Orthofracs team

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.