• C Mauffrey, D O Cuellar, F Pieracci, D J Hak, E M Hammerberg, P F Stahel, C C Burlew, and E E Moore.
• Denver Health Medical Center, 655 Broadway, Suite 365 Denver, Colorado 80203, USA.
• Bone Joint J. 2014 Sep 1;96-B(9):1143-54.

AbstractExsanguination is the second most common cause of death in patients who suffer severe trauma. The management of haemodynamically unstable high-energy pelvic injuries remains controversial, as there are no universally accepted guidelines to direct surgeons on the ideal use of pelvic packing or early angio-embolisation. Additionally, the optimal resuscitation strategy, which prevents or halts the progression of the trauma-induced coagulopathy, remains unknown. Although early and aggressive use of blood products in these patients appears to improve survival, over-enthusiastic resuscitative measures may not be the safest strategy. This paper provides an overview of the classification of pelvic injuries and the current evidence on best-practice management of high-energy pelvic fractures, including resuscitation, transfusion of blood components, monitoring of coagulopathy, and procedural interventions including pre-peritoneal pelvic packing, external fixation and angiographic embolisation.©2014 The British Editorial Society of Bone & Joint Surgery.

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