[The unstable patient with pelvic fracture]

For the hemodynamically unstable patient with pelvic fracture a target focussed and rapid diagnostic and therapy is mandatory. After hemorrhage control at crash site the direct transport in a trauma center follows. Primary therapy in the emergency room sometimes includes stabilization by a pelvic clamp or an external fixator. If the patient is still hemodynamically unstable the life threatening bleeding is packed. After that simple internal osteosynthesis is allowed. The presented article shows the possible options of the therapy. The main message is: hemorrhage control is not possible without stabilization of the pelvic ring.