Severe pelvic fractures: problems and possible solutions.

A host of injuries are associated with pelvic fractures, particularly of the severe disruptive type. It is important to recognize and treat severe pelvic fractures and associated injuries quickly. Multispecialty consultations should be sought when necessary. The control of hemorrhage secondary to pelvic fracture may be a difficult problem. A host of procedures have been described. Hypogastric artery interruption appears to be ineffective. However, angiographic embolization, compressive trousers, and, in a few selected patients, direct surgical intervention appear to be effective in controlling hemorrhage. The control of hemorrhage secondary to pelvic fracture may necessitate the use of more than the therapeutic modality. As emphasized by the Flint group,39 it is important to adopt an attack protocol. All too often, strategy has to be planned while a patient suffering a severe pelvic fracture continues to hemorrhage. When a particular method to control hemorrhaging fails, another should be employed. Open pelvic fractures are often difficult to manage. Initial efforts must be directed toward the control of hemorrhage. Secondary measures are required to minimize soft tissue soilage and infection, especially when there is deep perineal involvement. A logical, planned approach to pelvic trauma, with its associated injuries and blood loss, and appropriate specialty input are necessary for a successful outcome.