• Philip F Stahel, Clay C Burlew, and Ernest E Moore.
• aDepartment of Orthopaedics and Neurosurgery, School of Medicine, Denver Health Medical Center, University of Colorado, DenverbRocky Vista University College of Osteopathic Medicine, ParkercDepartment of Surgery, School of Medicine, Denver Health Medical Center, University of Colorado, Denver, Colorado, USA.
• Curr Opin Crit Care. 2017 Dec 1; 23 (6): 511-519.

Purpose Of ReviewComplex traumatic pelvic ring disruptions are associated with a high mortality rate due to associated retroperitoneal hemorrhage, traumatic-hemorrhagic shock, and postinjury coagulopathy. The present review provides an update on current management strategies to improve survival rates form hemodynamically unstable pelvic ring injuries.Recent FindingsRecently published international consensus guidelines have attempted to standardize the classification of hemodynamically unstable pelvic ring injuries and provided classification-based management algorithms for acute resuscitation and pelvic ring stabilization.SummaryAcute management strategies for pelvic ring disruptions with associated hemorrhagic shock include resuscitative endovascular balloon occlusion of the aorta for patients 'in extremis' in conjunction with point-of-care guided resuscitation for postinjury coagulopathy. Recent data indicate that a protocol of early pelvic external fixation in conjunction with direct preperitoneal pelvic packing and subsequent angioembolization in patients with ongoing hemorrhage results in significantly improved survival from retroperitoneal exsanguinating hemorrhage in at-risk patients with historic mortality rates as high as 50-60%.

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