A 40-year-old man sustains a high-energy pelvic fracture in a road traffic accident. He is hemodynamically unstable despite initial resuscitation. FAST examination is negative for intra-abdominal free fluid. What is the most appropriate next step to control hemorrhage?

• A Emergency laparotomy
• B CT pelvic angiography followed by selective embolization
• C Pelvic packing and/or angioembolization after applying a pelvic binder and temporary external fixator ✓
• D Blood transfusion and ICU admission

Explanation

Hemodynamically unstable pelvic fractures cause life-threatening retroperitoneal hemorrhage, primarily from venous plexuses and fractured cancellous bone surfaces. Initial management includes applying a pelvic binder to reduce pelvic volume and tamponade venous bleeding. The two main hemostasis strategies are: preperitoneal pelvic packing (PPP) for venous hemorrhage, and angiographic embolization for arterial hemorrhage (most effective for anterior pelvic fractures with arterial injury). In most trauma centers, angioembolization and/or pelvic packing are performed before laparotomy when abdominal hemorrhage is excluded. A temporary external fixator may stabilize the pelvis. CT angiography is performed in hemodynamically stable patients only.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.