In 1996 the quality of the early management of 100 consecutive patients referred to a regional pelvic and acetabular unit between 1989 and 1992 was studied. The management of these patients was assessed in four specific areas, and guidelines were laid down. It was found that in 56% of patients the early management did not meet these suggested standards, with 34% having deficiencies in more than one area. These results were presented, published and circulated to referring hospitals.

Five years later, the early management of a further 100 consecutive referrals was assessed using these same guidelines. The treatment of 57% of patients still did not reach the guideline standards, but the number with problems in more than one area fell to 20%.

There has been some improvement in the early management of pelvic and acetabular injuries. The use of external fixators to control severe haemorrhage increased, but frames were often poorly applied. Wider access to CT scanners has reduced delays in definitive imaging.

Associated injuries are still regularly overlooked, and occasionally treatment of ipsilateral hip or femur fractures compromises pelvic surgery. Early communication with the specialist centre is encouraged but unfortunately delays in referral are still common.