Hemorrhage control in pelvic injuries

Pelvic ring fractures are rare but potentially life-threatening injuries due to hemorrhage and hemodynamic instability. Severe blood loss is the leading cause of death in unstable pelvic injuries. The early identification of pelvic hemorrhage is therefore crucial for survival of patients and requires immediate emergency treatment. Detailed knowledge of the anatomical and pathophysiological principles is of great importance, whereby the majority of hemorrhages following pelvic fractures are of venous origin. The control of bleeding is best accomplished with pelvic packing but is, however, initially not possible in the case of pelvic instability induced by fractures; therefore, the concept of stabilization followed by pelvic tamponade is gaining in importance as reflected in the most recent recommendations in the literature. The aim of this article is to review these latest findings, to discuss the newest developments in the therapy of extensive pelvic injuries and to sketch a clearly structured algorithm for the treatment of hemorrhage control in pelvic injuries.