Control of severe pelvic fracture hemorrhage with pelvic packing

The mortality of pelvic fracture caused by high energy trauma is very high. If the fracture is combined with massive blood loss, the mortality will reach 50%-60%. (1,2) The bleeding site usually origins from retroperitoneum. Unstable pelvic fracture can easily cause continuous retroperitoneal bleeding which is bound to a hemorrhagic shock state. So it is critical to prevent retroperitoneal bleeding as the first step to save the patient's life, which seems to be more efficient than transfusion. (3) Interventional angiographic procedure and pelvic packing have been taken to control life-threatening hemorrhage. (4,5) Controversy exists on how to control exsanguiating hemorrhage more efficiently after trauma. Herein, we reported the excellent efficacy of direct retroperitoneal packing in two patients who remained hemodynamically labile after taking resuscitative measures and discussed the role of pelvic packing to control massive hemorrhage in unstable pelvic fractures.