Synopsis
Recognise pelvic ring injury as a concealed bleeding source, apply and monitor a binder correctly, detect associated urogenital damage, and choose rapid packing, fixation or embolisation pathways.
- Suspect pelvic bleeding after high-energy blunt trauma with shock, pelvic pain, perineal signs or an unreliable examination; avoid repeated compression or distraction testing.
- Place a purpose-made binder around the greater trochanters, not the iliac crests or abdomen, pull to the device specification and confirm position clinically and radiographically.
- A binder is temporary haemorrhage control; continue warmed blood, TXA within 3 hours, calcium and coagulation management and definitive pelvic source-control planning.
Key red flags
High-energy mechanism with shock, pelvic or sacral pain, perineal bruising, limb-length change or mechanical instability should be treated as pelvic haemorrhage until assessed and controlled.
Investigation priorities
Identify major ring disruption during unstable resuscitation and check binder level.
Define fracture pattern, active bleeding and associated organ injury.
Management branches
Pelvic injury is suspected with haemodynamic instability or a high-risk mechanism and unreliable examination.
- Apply the binder over the greater trochanters with minimal movement, avoid springing and document distal neurovascular status and application time.
- Activate major-haemorrhage support, use warmed blood, give timely tranexamic acid and correct temperature, calcium and clotting deficits.
Key medicines
Tranexamic acidFor suspected major pelvic bleeding, give 1 g intravenously over 10 minutes followed by 1 g infused over 8 hours, beginning as early as possible and within 3 hours of injury.