Basic Management of Pelvic Fractures

The management and treatment of complex pelvic fractures require knowledge of the initial evaluation of a trauma patient, pertinent anatomy, and techniques available for hemorrhage control. Trauma patients with complex pelvic fractures are at high risk for hemorrhage and require thoughtful and expeditious management. A multidisciplinary team including a trauma surgeon, an orthopedic surgeon, and an interventional radiologist is required for optimal treatment of these complex injuries. The team must be managed by the trauma surgeon to guide ongoing resuscitation as the patient may travel throughout the hospital to undergo several interventions to control hemorrhage. A number of techniques can be emergently implemented for fracture stabilization and hemorrhage control, including temporary application of a pelvic binder, preperitoneal pelvic packing, external fixation, and angioembolization. The patient’s clinical status, fracture pattern, and bleeding source must be considered when deciding which hemorrhage control techniques should be performed. New temporary hemorrhage control interventions, such as resuscitative endovascular balloon occlusion of the aorta, have shown early success in control of pelvic fracture–related hemorrhage and require further investigation. Pelvic fractures are associated with a number of neurovascular and genitourinary injuries, which can carry long-term morbidity. This review discusses the diagnosis, management, and treatment of complex pelvic fracture and associated hemorrhage. This review contains 5 figures, and 55 references. Key words: angioembolization, pelvic fixation, pelvic fracture, preperitoneal packing, resuscitative endovascular balloon occlusion of the aorta