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J Am Acad Orthop Surg, Vol 17, No 7, July 2009, 447-457.
© 2009 the American Academy of Orthopaedic Surgeons
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Management of Hemorrhage in Life-threatening Pelvic Fracture

David J. Hak, MD, MBA, Wade R. Smith, MD and Takashi Suzuki, MD

Dr. Hak is Associate Professor, Department of Orthopaedic Surgery, Denver Health/University of Colorado, Denver, CO. Dr. Smith is Professor, Department of Orthopaedic Surgery, Denver Health/University of Colorado. Dr. Suzuki is AO Research Fellow, Denver Health/University of Colorado, and Assistant Professor, Orthopaedic Trauma, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.

Dr. Hak or a member of his immediate family is affiliated in an unpaid capacity with the publications Journal of Orthopaedic Trauma and Orthopedics, is a member of a speakers’ bureau or has made paid presentations on behalf of Medtronic and Eisai, serves as a paid consultant to or is an employee of Medtronic, and has received research or institutional support from Synthes and Stryker. Dr. Smith or a member of his immediate family is affiliated in an unpaid capacity with the publication Patient Safety in Surgery, is a member of a speakers’ bureau or has made paid presentations on behalf of Stryker and Synthes, serves as a paid consultant to or is an employee of Synthes, and has received research or institutional support from Acumed. Neither Dr. Suzuki nor a member of his immediate family has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article.

Reprint requests: Dr. Hak, Department of Orthopaedic Surgery, Denver Health/University of Colorado, 777 Bannock Street, MC 0188, Denver, CO 80204.

Emergent life-saving treatment is required for high-energy pelvic fracture with associated hemorrhage and hemodynamic instability. Advances in prehospital, interventional, surgical, and critical care have led to increased survival rates. Pelvic binders have largely replaced military antishock trousers. The availability and precision of interventional angiography have expanded considerably. External pelvic fixation can be rapidly applied, often reduces the pelvic volume, and provides temporary fracture stabilization. Pelvic packing, popularized in Europe, is now used in certain centers in North America. The use of standardized treatment algorithms may improve decision making and patient survival rates. Active involvement of an experienced orthopaedic surgeon in the evaluation and care of these critically injured patients is essential.






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Copyright © 2009 by the American Academy of Orthopaedic Surgeons.