A 28-year-old motorcyclist arrives with suspected pelvic fracture and hemodynamic instability. X-ray shows an 'open book' pelvic fracture. Initial hemorrhage control should include:

• A Pelvic binder application (or sheet binding) to reduce pelvic volume, followed by REBOA or angioembolization if unstable ✓
• B Immediate exploratory laparotomy for pelvic vessel ligation
• C External fixator application under general anesthesia as the primary intervention
• D CT angiography as the first investigation before any intervention

Explanation

For open-book pelvic fractures with hemodynamic instability, immediate pelvic binder or sheet binding compresses the pelvis and reduces intrapelvic volume, tamponading venous (presacral plexus) bleeding. This is the critical first step in ATLS management. If instability persists, Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) at Zone III provides temporary hemorrhage control and bridges to angioembolization (preferred for arterial bleeding) or pelvic packing. Laparotomy is reserved for concomitant intra-abdominal injury; external fixation is definitive but not first-line in the acute unstable patient.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.