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In the chaotic environment of a mass casualty or severe roadway crash, clinicians must distinguish pelvic injury from other life-threatening problems while maintaining overall stability. Early pelvic stabilization should begin with scene-safe assessment and rapid triage to identify patients who require immediate immobilization. Use manual stabilization only as a temporary measure until a definitive device can be applied. When feasible, involve experienced personnel such as a trauma surgeon or orthopedic technician to guide chest and abdomen assessment, airway management, and hemorrhage control in parallel with pelvis stabilization. Documentation of findings and time stamps assists subsequent interventions and interprofessional coordination.

Pelvic stabilization hinges on applying a purpose-built belt or sheet device that distributes force evenly across the pelvis rather than focusing on a single point. The technique minimizes secondary injury and reduces pelvic volume, which can lessen venous oozing. Select a wide, non-elastic strap or commercial pelvic binder appropriate for the patient’s size. Position it at the level of the greater trochanters, ensuring even tension without compressing the abdomen. If a binder is unavailable, a properly applied sheet can substitute, but it requires careful folding and secure ties to avoid slipping. Reassess periodically to adjust tension as the patient’s condition evolves.

The decision to apply external stabilization should happen as soon as possible after initial resuscitation begins. External devices must be checked for fit, alignment, and potential skin compromise. When applying a binder, avoid excessive tightness that could impair diaphragmatic excursion or venous return. Monitor the patient for signs of deterioration, including rising heart rate, decreasing blood pressure, and increasing pain or pressure under the binder. Communicate with the surgical team about the patient’s stability, suspected fracture pattern, and anticipated imaging needs. Document the exact device type, size, placement, and any adjustments, enabling continuity of care across shifts and facilities.

Imaging after stabilization determines definitive management. Portable radiographs and focused ultrasound can help assess pelvic ring disruption and associated injuries. The radiology team should be alerted early to the likelihood of significant hemorrhage or organ injury, guiding transfusion planning and surgical scheduling. Meanwhile, maintain permissive hypotension strategies within safe limits to avoid dislodging clots while ensuring organ perfusion. Interdisciplinary discussions should occur to decide if interventional radiology, exploratory laparotomy, or hybrid procedures are indicated. Throughout imaging, protect the patient from additional trauma by ensuring secure immobilization and careful handling.

In the field or ambulance, rapid immobilization using a pelvic binder is often the safest option. The practitioner should confirm patient consciousness, pain levels, and the ability to tolerate movement while applying the device. When a patient has concurrent spinal precautions, ensure the binder does not interfere with cervical stabilization or airway access. In cases of obesity or edema, select a larger size and adjust with additional padding to avoid excessive constriction. After application, reassess neurovascular status in the hips and legs, and verify distal perfusion. If signs of neurovascular compromise emerge, re-evaluate alignment and tension and consider removing and reapplying the binder with a more precise fit.

Ongoing monitoring in the prehospital and early hospital period focuses on hemorrhage control and organ protection. Establish two large bore IV lines and prepare blood products for potential rapid transfusion. Continuous vital sign monitoring should track trends in heart rate, blood pressure, respiratory rate, and oxygen saturation. Pain management remains important but should be balanced against the risk of masking signs of deterioration. Communicate clearly with the patient and family about procedures and goals, and document any sensory changes or motor weakness. Coordination with the receiving team improves the speed of definitive care when the patient arrives at the hospital.

Pelvic fractures carry a high risk of life-threatening hemorrhage through venous channels or arterial injury. External stabilization helps reduce pelvic volume and tamponade bleeding, but definitive control often requires surgical or endovascular intervention. Early activation of a trauma team, blood bank, and operating room or interventional suite ensures rapid progression to definitive care. The team should designate a lead for airway, breathing, circulation, and disability, with assistants assigned to monitor devices and document events. Clear handoffs between EMS, ED staff, radiology, and surgery reduce delays. Regular briefings with time stamps help track progress toward definitive stabilization and definitive repair.

Once imaging indicates an unstable pelvic fracture, preparation for definitive intervention begins. The surgical plan may include external fixation, angioembolization, or surgical repair, depending on the fracture pattern and patient physiology. Team members must anticipate potential complications, such as coagulopathy, infection risk, and organ injury. Preoperative optimization involves correcting coagulopathy, maintaining normovolemia, and preventing hypothermia. Throughout these steps, continuous reassessment of neurovascular status and pain control keeps the patient safe and comfortable. Effective communication ensures that all caregivers understand the sequence of procedures and anticipated time frames for repair.

External fixation can serve as a bridge to definitive surgery in many cases. The procedure provides temporary stability, reduces movement at fracture sites, and can help control pain. Position the patient to minimize abdominal pressure and prevent respiratory compromise. Select fixation pins and bars that fit the patient’s anatomy, and ensure secure attachment without causing additional tissue injury. Monitor for pin-site infection and neurovascular compromise, addressing any concerns promptly. Coordinate with the anesthesia and surgical teams to anticipate blood loss and expedite transport to the operating room or interventional suite when needed.

In parallel, interventional radiology offers a minimally invasive path to hemorrhage control. Embolization targets arterial bleeding and can dramatically reduce transfusion requirements. The interventional team should be prepared to proceed under general anesthesia with appropriate monitoring. Rapid access to imaging, a stocked set of embolic materials, and close collaboration with trauma surgery improve outcomes. Keep the patient warm and hemodynamically stable during the transfer to the radiology suite. Effective communication about the patient’s status and imaging findings helps prioritize definitive treatment without delaying care.

The final stage of stabilization involves arranging definitive fracture management. If the patient is a candidate for internal fixation or pelvic reconstruction, timely transfer to the operating room is essential. Ensure that blood products remain available and that anesthesia teams are prepared for potential hemodynamic shifts during lengthy procedures. Postoperative plans should include pain control, DVT prophylaxis, and early mobilization when appropriate. Multidisciplinary rounds after surgery help ensure that complications are identified early and addressed with targeted therapies. Documentation should reflect intraoperative findings and postoperative orders for seamless continuity of care.

After stabilization and surgery, rehabilitation begins as soon as the patient is stable. Early physical therapy supports restoration of mobility, reduces the risk of complications from prolonged bed rest, and promotes functional recovery. Nutritional optimization and sleep hygiene contribute to healing, while psychosocial support helps patients cope with the trauma and its consequences. Clear discharge planning, home safety assessments, and caregiver education improve long-term outcomes. Regular follow-up with orthopedics, radiology, and rehabilitation services ensures that healing progresses as expected and that any late sequelae are caught early.