• David Mejia, Michael W Parra, Carlos A Ordoñez, Natalia Padilla, Yaset Caicedo, Salin Pereira Warr, Paula Andrea Jurado-Muñoz, Mauricio Torres, Alfredo Martínez, José Julián Serna, Fernando Rodríguez-Holguín, Alexander Salcedo, Alberto García, Mauricio Millán, Luis Fernando Pino, González HadadAdolfoAUniversidad del Valle, Facultad de Salud, Escuela de Medicina, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia.Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care, Mario Alain Herrera, and Ernest E Moore.
• Hospital Pablo Tobon Uribe, Department of Surgery, Medellin, Colombia.
• Colomb Medica. 2020 Dec 30; 51 (4): e4214510.

AbstractPelvic fractures occur in up to 25% of all severely injured trauma patients and its mortality is markedly high despite advances in resuscitation and modernization of surgical techniques due to its inherent blood loss and associated extra-pelvic injuries. Pelvic ring volume increases significantly from fractures and/or ligament disruptions which precludes its inherent ability to self-tamponade resulting in accumulation of hemorrhage in the retroperitoneal space which inevitably leads to hemodynamic instability and the lethal diamond. Pelvic hemorrhage is mainly venous (80%) from the pre-sacral/pre-peritoneal plexus and the remaining 20% is of arterial origin (branches of the internal iliac artery). This reality can be altered via a sequential management approach that is tailored to the specific reality of the treating facility which involves a collaborative effort between orthopedic, trauma and intensive care surgeons. We propose two different management algorithms that specifically address the availability of qualified staff and existing infrastructure: one for the fully equipped trauma center and another for the very common limited resource center.Copyright © 2020 Colombia Medica.

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