Document Type : Review Article

Authors

• Elnaz Olama ¹
• Omid Nikoo ²
• Salma Dehbozorgi ³
• Elham Hassannia ⁴
• Zahra Jafarzadeh Jahromi ⁵
• Amin Azad ⁶
• Majid Salamati ⁷

¹ Faculty of Medicine, Georgian National University SEU, Tbilisi 0166, Georgia.

² Faculty of medicine, shiraz university of medical sciences, shiraz, iran

³ Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, Iran

⁴ faculty of medicine, kerman university of medical sciences, Kerman, Iran

⁵ Faculty of medicine, Jahrom university of medical sciences, Jahrom, Iran

⁶ Department of Orthopedics, Babol University of Medical Sciences, Babol, Iran

⁷ Department of Surgery, School of Medicine, Emam Khomeini Hospital, Ilam University of Medical Sciences, Ilam, Iran

Abstract

Objectives: This systematic review aimed to evaluate and compare emergency hemorrhage control
interventions for hemodynamically unstable pelvic fracture trauma, assessing clinical outcomes, including
mortality, transfusion requirements, and complication rates.
Methods: A comprehensive literature search of PubMed, Scopus, Web of Science, and Google Scholar was
conducted in December 2024. Studies were selected based on predefined inclusion criteria, which considered
adult patients (≥18 years) with hemodynamically unstable pelvic fractures. Data extraction and quality
assessment were performed using standardized tools. Interventions of interest included preperitoneal pelvic
packing (PPP), angioembolization (AE), resuscitative endovascular balloon occlusion of the aorta (REBOA),
and mechanical stabilization.
Results: Ten studies were included. PPP and AE demonstrated comparable in-hospital mortality rates. However,
PPP was associated with shorter intervention times and reduced early transfusion requirements. Mechanical
stabilization was universally recommended as an initial step, while REBOA served as a temporizing measure.
The overall strength of evidence was moderate, derived primarily from retrospective studies and meta-analyses,
with no randomized controlled trials identified.
Conclusion: Both PP and AE were effective for hemorrhage control in hemodynamically unstable pelvic fractures,
with the choice of first-line intervention often dependent on logistical factors. The development of standardized
protocols and prospective studies should be prioritized in future work to optimize management strategies.

Keywords

• Pelvic fracture
• Hemorrhage control
• Preperitoneal packing
• Angioembolization