Pelvic fractures resulting from high-energy mechanisms can be deadly. Internal bleeding from pelvic fractures can be both arterial and venous. Bleeding into the retroperitoneal space, which is large enough to hold the patient’s entire blood volume, can result in fatal hemorrhage. EMS and initial hospital recognition of unstable pelvic fractures and their stabilization, as well as an understanding of the potential intervention, can improve patient survival.
In some series, pelvic fractures have shown a 10% mortality, which has been 37% for patients greater than 60 years old. If a patient is conscious and is able to convey pelvic pain, that should raise the suspicion of a pelvic fracture. Proper and careful compression of the pelvis can help determine pain and instability. Correct placement of a pelvic sheet wrap or pelvic binder can help with pain and hypotension. Definitive care of pelvic fractures can involve surgery and control of bleeding with interventional angiography, but the initial assessment and intervention can make an important clinical difference.