Initial Management of Pelvic Fractures

Purpose of Review: Pelvic fractures represent a complex and unique challenge to trauma providers, both in the civilian and military settings. They are often associated with severe concomitant injuries and optimal care of life-threatening hemorrhage requires a truly multi-disciplinary approach. This review will provide a general overview of pelvic fractures including epidemiology, assessment, management, and outcomes. Additionally, it will assess the most up to date findings on pelvic fracture management with particular focus on life-threatening hemorrhage control. Recent Findings: There are several interventions under investigation to address hemorrhage from severe pelvic fractures. These include pelvic binder placement, external fixation, pre-peritoneal packing, angiography with embolization, and more recently the use of the Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) catheters. Each one of these interventions have their own unique advantages and disadvantages with significant regional and institutional variance. The optimal order, timing, setting, and combinations of these interventions are points of ongoing study. Summary: Life-threatening hemorrhage from pelvic fractures, regardless of the practice setting, present a difficult challenge for trauma teams. There are a number of therapeutic tools, often utilized by different specialties. Where and when to utilize these tools requires further investigation but will likely vary based on the individual patient and particular practice setting.