(ii) Acute management of pelvic ring fractures

During the primary survey, patients with pelvic ring fractures undergo decision making for day 1 surgery including life-saving surgery, damage control surgery and early total care or delayed definitive surgery dependent on haemodynamic status, physiologic criteria (hypothermia, coagulopathy, acidosis), scoring of injury severity and personal or operative resources. The staged sequential procedures of 'pelvic damage control' include damage control surgery with control of haemorrhage and contamination, decompression of abdominal and pelvic compartment syndromes, débridement of soft tissue injuries as well as temporary or definitive osteosynthesis, followed by resuscitation in the intensive care unit, 'second-look' operations, scheduled definitive surgery and secondary reconstructive surgery. External fixation of the posterior pelvic ring by pelvic C-clamp and pelvic packing represent the work horses for haemorrhage control of severe pelvic ring injuries in haemodynamically unstable patients, whereas angiographic embolisation is an option for haemodynamically stable patients or persistent bleeding after or during damage control surgery.