1. Vascular. Haemorrhage from a pelvic fracture is often dramatic, either from the sacral venous plexus and other great veins, or an arteiy in close proximity to bone. The superior gluteal artery is the most frequently damaged, as it passes through the sciatic notch. Significant haemorrhage may also occur from exposed bony surfaces.
2. Urological. Urethral injury, more common in males, occurs in 15% and bladder rupture occurs in 5% of pelvic fractures. Injuries to the ureter are rare. Urethral injuries manifest as blood at the meatus, penile bruising, a high riding prostate on PR examination, or haematuria. Urological advice is required before attempted catheterization. Suprapubic catheterization is often preferable and further investigation includes a retrograde urethrogram, cystogram, intravenous pyelogram (IVP) or CT scan.
3. Neurological. Sacral fractures through neural foramina may compromise the lumbosacral plexus. The sciatic and other nerves may be damaged, depending on the injury pattern.
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