Emergent management of pelvic ring injuries: an update.

prise about 2% of all fractures, but the incidence is increasing due to increasing numbers of high-speed vehicular crashes and suicide attempts. Mortality associated with isolated pelvic injury, independent of severity, has been reported to be low: 1%–2%. Among multiply injured victims of blunt trauma, however, almost 20% have injuries to the pelvic ring. In this group, when closed pelvic ring disruption is associated with multiple injuries, the mortality rate rises to 10%–15%. Pelvic fractures associated with intra-cranial mass lesions or notable abdominal injuries have mortality rates as high as 50%. The mortality associated with open pelvic fractures has been shown to be 30%– 50%. The parameters that predict mortality are age, injury severity score (ISS) and the existence of severe hemorrhage. Exsanguinating hemorrhage is the major cause of death in the first 24 hours after trauma. Immediate recognition of hemorrhagic shock and effective control of bleeding must be pivotal in every resuscitation effort. Appropriate recognition and management of serious pelvic fractures is also integral to resuscitative strategy. Management of these potentially lethal injuries requires expedited stabilization by a multidisciplinary team of trained personnel with a defined treatment protocol. Multidisciplinary clinical-pathway and coordinated joint decision-making improves patient survival. A postmortem study by Wright and colleagues has shown that the average ISS of patients dying from pelvic fractures was much higher in patients treated by a protocol of care than in those treated with a “non-system” approach on an ad-hoc basis. As the understanding of these potentially fatal injuries improves, priorities of early management of pelvic ring injuries are evolving. This review article summarizes the current trend in emergent management of pelvic fractures, based on available evidence. A protocol designed to facilitate organized and systematic care of the serious pelvic fracture in multi-system trauma is proposed.