Management of severe bleeding in fractures of the pelvis.

The successful control of severe hemorrhage secondary to pelvic fracture can be a difficult problem. This is not surprising considering the extensive vascularity of the pelvic sink with its collateral circulation of major vascular loops. Appreciation of this complex anatomy should alert physicians to sources of severe hemorrhage and guide their therapeutic decisions. Although many techniques are available for reducing hemorrhage, no one technique has universally produced successful results. Whatever method is initially used, surveillance to recognize a therapeutic failure is necessary. If bleeding continues, other methods should be used. A planned systematic approach based on the availability of various modalites to achieve hemostasis is suggested.