Acute Pelvic Packing

In high-energy trauma, a pelvic fracture can be a life-threatening source of hemorrhage. Management of patients with an exsanguinating pelvis requires a clear, multidisciplinary institutional protocol for the best possible outcomes. A management algorithm of severe pelvic fracture is presented with a focus on surgical preperitoneal pelvic packing as the primary method of hemorrhage control. Angioembolization is utilized as a secondary intervention after pelvic packing for ongoing hemodynamic instability. Pelvic packing is a straightforward surgical procedure performed through a Pfannenstiel skin incision. It is performed in conjunction with bony stabilization of the pelvis, either through external fixation or through anterior plating. Surgical hemostasis with pelvic packing for the trauma patient in extremis can be performed expediently and has been shown to result in outcomes as effective as angiography.