Suspected Pelvic Fracture
High-energy trauma with pelvic pain/instability
All Pathways
Orthopedic SurgeryEmergency
Pelvic Fracture Hemorrhage Management (EAST/WSES)
Pelvic Fracture Hemorrhage Management (EAST/WSES): Suspected Pelvic Fracture → ATLS Primary Survey + Pelvic Binder → Hemodynamic Status? → Hemodynamical...
Pathway Overview
17 steps
Algorithm Steps
17 total
01Start 02Action ATLS Primary Survey + Pelvic Binder
Immediate stabilization
- ABCDE assessment
- Apply pelvic binder at level of greater trochanters
- Do NOT spring pelvis (one exam only)
- Massive transfusion protocol if indicated
- Control other hemorrhage sources
03Decision Hemodynamic Status?
SBP <90 or HR >120 or not responding to resuscitation
04Action Hemodynamically Stable
Proceed to CT imaging
- CT pelvis with IV contrast
- Assess fracture pattern (Young-Burgess/Tile)
- Identify contrast blush (arterial bleeding)
- Assess for associated injuries
- Keep binder in place
05Action Classify Fracture Pattern
Young-Burgess / Tile Classification
- LC (Lateral Compression): Most common, lower mortality
- APC (Anterior-Posterior Compression): Open book, high mortality
- VS (Vertical Shear): Highest mortality
- Combined mechanisms
- Pattern predicts bleeding severity
06Action Definitive Fixation
Staged approach when stable
- ORIF when hemodynamically stable
- Timing: 5-14 days post-injury typically
- Anterior plating for symphysis/rami
- Posterior fixation (SI screws, plate)
- May convert ex-fix to internal
07Outcome Hemorrhage Controlled
Proceed to definitive care
08Warning High Mortality Risk
Pelvic fracture mortality 10-50% if unstable
09Warning ⚠️ High-Risk Factors for Angiography
EAST recommendations
- Age >60 with major pelvic fracture
- Arterial contrast extravasation on CT
- Hemodynamic instability with negative FAST
- Open book, butterfly, or vertical shear pattern
- Consider angio even if transiently stable
10Action Angioembolization
For arterial bleeding
- If arterial blush on CT or ongoing hemorrhage
- EAST: Consider in age >60 with major fracture regardless of HD status
- Selective embolization preferred
- May need after PPP if still bleeding
- Requires IR availability
- Path rejoins step 06Shared downstream outcome
11Action Hemodynamically Unstable
Do NOT go to CT - direct intervention
- Keep in resuscitation bay or go to OR
- Massive transfusion protocol
- Confirm pelvic binder properly placed
- FAST/E-FAST to rule out other sources
12Decision FAST Positive?
Intraperitoneal hemorrhage present?
13Action FAST Positive - Laparotomy
Intraperitoneal hemorrhage takes priority
- Emergent exploratory laparotomy
- Address abdominal bleeding
- Consider preperitoneal pelvic packing at same time
- External fixation if available
14Action Preperitoneal Pelvic Packing (PPP)
Rapid surgical hemorrhage control
- Suprapubic incision, extraperitoneal approach
- Pack bilateral preperitoneal space with laparotomy pads
- Addresses venous/bony bleeding
- Combine with pelvic stabilization (C-clamp or ex-fix)
- Particularly if no angio available
- Return to OR in 24-48h for pack removal
15Action External Fixation / C-Clamp
Mechanical stabilization
- Reduces pelvic volume
- C-clamp for posterior ring injuries
- Anterior external fixator for APC injuries
- Combine with PPP for best effect
- Path rejoins step 06Shared downstream outcome
- Path rejoins step 10Shared downstream outcome
16Action FAST Negative - Pelvic Source
Bleeding likely retroperitoneal/pelvic
- Pelvic hemorrhage is primary source
- Proceed to hemorrhage control
- Options: PPP, angioembolization, REBOA
- Path rejoins step 14Shared downstream outcome
- Path rejoins step 10Shared downstream outcome
17Action REBOA (Zone III)
Bridge to definitive treatment
- Resuscitative Endovascular Balloon Occlusion of Aorta
- Infrarenal (Zone III) for pelvic hemorrhage
- Provides temporary hemorrhage control
- Bridge to OR or angio suite
- Limited occlusion time (<60 min)
- Path rejoins step 14Shared downstream outcome
Guideline Source
EAST PMG: Pelvic Fracture Hemorrhage + WSES Pelvic Trauma Guidelines
Clinical Safety Information
Clinical Decision Support — Not a Substitute for Clinical Judgment
Individual patient factors may require deviation from these recommendations.
Known Limitations
- Management varies by institutional resources (angio availability)
- REBOA availability limited to trauma centers
- Pediatric pelvic fractures differ in management
- Multidisciplinary trauma team essential
Applicable Regions
USEU
Version 1Next review: 2027-01-11
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Related Resources
Frequently Asked Questions
What is the Pelvic Fracture Hemorrhage Management (EAST/WSES)?
The Pelvic Fracture Hemorrhage Management (EAST/WSES) is a emergency clinical algorithm for Orthopedic Surgery. It provides a structured decision tree to guide clinical decision-making, based on EAST PMG: Pelvic Fracture Hemorrhage + WSES Pelvic Trauma Guidelines.
What guideline is the Pelvic Fracture Hemorrhage Management (EAST/WSES) based on?
This algorithm is based on EAST PMG: Pelvic Fracture Hemorrhage + WSES Pelvic Trauma Guidelines (DOI: 10.1186/s13017-017-0117-6).
What are the limitations of the Pelvic Fracture Hemorrhage Management (EAST/WSES)?
Known limitations include: Management varies by institutional resources (angio availability); REBOA availability limited to trauma centers; Pediatric pelvic fractures differ in management; Multidisciplinary trauma team essential. Individual patient factors may require deviation from these recommendations.
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