1a Control of haemorrhage

• Haemostatic resuscitation
• Pelvic binder
• Intervention radiology for angiography embolization if arterial bleed present
• Packing in theatre primarily stems venous bleeding or is used for unstable patients (pre-peritoneal packing or retroperitoneal packing) or if embolization has been unsuccessful
• Damage control surgery usually occurs first before trying to fix
• Mechanical stabilisation of pelvic fracture by external fixation

Leading cause of death in pelvic injury is BLEEDING!

Venous haemorrhage is thought to account for nearly 90% of pelvic fractures and arterial haemorrhage only 10%⁵. True pelvic volume is about 1.5L but this volume increases with disruption of the pelvic ring. Haemorrhage from a pelvic fracture is essentially bleeding into a free space, which is capable of accommodating the patient’s entire blood volume without exerting a tamponade effect. Blood can escape into the peritoneum, thighs and retro-peritoneal space which can accumulate 5L in volume with only a pressure rise of 30mmHg⁵.

Learning bite

Nearly 90% of pelvic fracture bleeding is venous in origin.