Hemorrhage and pelvic fractures

Hemorrhage is the major cause of death in pelvic fractures. In closed pelvic fractures the bleeding is usually self-limited. In the small number of patients with continuing hemorrhage there may be disruption of a major iliac vessel, which will require immediate exploration and repair. In a few patients continuing hemorrhage is due to disruption of a branch of the hypogastric artery, which may be identified by angiography and controlled by embolization. A management protocol is suggested for these patients.