Haemorrhage control in pelvic trauma

A pelvic fracture usually indicates high energy transfer from a significant mechanism and a high likelihood of associated injuries. Mortality from pelvic trauma is usually due to massive haemorrhage mandating expedient resuscitation of the patient and immediate control of exsanguinating haemorrhage. Damage control resuscitation incorporates permissive hypotensive resuscitation and early replacement of clotting factors with early aggressive surgical control of bleeding. A commercially available pelvic binder provides circumferential compression and rapidly closes the pelvis, leading to fracture splintage and reduction in pelvic volume, both of which reduce haemorrhage. It is critical to distinguish ongoing bleeding due to a pelvic ring injury from intra-peritoneal haemorrhage. The identification of intra-peritoneal bleeding in a haemodynamically unstable patient mandates laparotomy. On-going haemorrhage from the pelvis requires diagnostic pelvic angiography, followed by selective embolisation if a source of bleeding is identified. If angiography is not available pelvic packing can be life-saving.