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Updated: Feb 12, 2026

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Severe Bleeding in Pelvic Fractures: Considerations in Planning Damage Control.

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    Area of Science:

    • Trauma Surgery
    • Vascular Surgery
    • Emergency Medicine

    Background:

    • Severe bleeding from pelvic fractures necessitates damage control interventions like preperitoneal packing.
    • Preperitoneal packing is frequently performed without complete abdominal exploration, raising concerns about missed injuries.
    • Major iliac vascular and intraabdominal injuries can be associated with severe pelvic fractures.

    Purpose of the Study:

    • To assess the incidence of common or external iliac vascular lacerations (CEIVL) and associated intraabdominal injuries in patients with severe pelvic fractures.
    • To identify predictors for CEIVL in this patient population.

    Main Methods:

    • Retrospective analysis of the National Trauma Data Bank.
    • Inclusion of blunt trauma patients with severe pelvic fractures.
    • Recording of CEIVL and intraabdominal injuries, including bladder and bowel trauma.

    Main Results:

    • The study included 42,122 pelvic fracture patients, with 3,221 (7.6%) having severe fractures.
    • The incidence of CEIVL in severe pelvic fractures was 10.7%.
    • Patient age ≥ 65 years was an independent predictor of CEIVL.
    • 34.3% of severe pelvic fracture patients sustained severe intraabdominal injuries, including bladder (26.5%) and bowel (16.7%) injuries.

    Conclusions:

    • Severe pelvic fractures are frequently associated with significant iliac vascular and intraabdominal injuries.
    • Preperitoneal pelvic packing without thorough abdominal exploration may lead to underdiagnosis of these critical injuries.
    • Clinical vigilance and potentially modified surgical approaches are warranted for patients with severe pelvic fractures.