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The diagnosis of a traumatic unstable pelvis in a stable patient is a temporary concept depending on when we see the patient, as all patients presenting with hemorrhagic shock have hemodynamic stability until they become unstable. As a rule, the more unstable the pelvic fracture is, the higher the risk of bleeding and hemodynamic instability it has. Therefore, in unstable pelvic fractures, hemodynamic stability should be a diagnosis by exclusion. For bleeding detection in stable patients, an immediate one-stage contrast-enhanced CT scan is the appropriate diagnosis test; however, since CT scan radiation is always an issue, X-rays should be considered in those cases of hemodynamically stable patients in whom there is a reasonable suspicion that no unsafe bleeding is going on. Pelvic fracture classification is essential as usually there is an association between the injury mechanism, the fracture displacement, and the hemodynamic stability. Anteroposterior and, particularly, vertical traumatisms have much more proclivity to provoke major pelvic displacement and bleeding. The use of a pelvic binder, as early as possible including pre-hospital management, should be standard in high-impact blunt trauma patients independently of the trauma mechanisms. External fixation is the preferred method of stabilization in case of open fractures, and, in closed ones, when the schedule for definite osteosynthesis prolongs because of the patient’s general condition. If possible, immediate percutaneous sacroiliac screw insertion for unstable pelvic fractures produce excellent results even in open fractures.

Fractures of the pelvic ring are significant injuries that affect diverse population groups. They range from low-energy, stable fractures to high-energy, unstable injuries with a substantial morbidity and mortality. The osseous and ligamentous relationships involved in maintaining the stability of the pelvis are complex, and knowledge of these is essential to appropriately manage pelvic fractures. The mechanism of injury and force vectors involved may be used to predict pelvic instability, likely additional injuries, and management strategies. Initially, temporary stabilization, blood-based resuscitation, and appropriate imaging are required. Further haemorrhage control, via embolization, may be required. Urogenital injuries should be identified and treated early. Definitive pelvic fixation should take place once haemodynamic compromise has been reversed and normal parameters maintained, and should aim to restore anatomic alignment and pelvic stability. In addition to the acute risk of major haemorrhage and death, pelvic fractures are associated with long-term morbidity due to gait disturbances, chronic pain, non-union, mal-union, and neurological and urogenital disruption. Therefore, the management of pelvic fractures provides a challenge for clinicians from their initial presentation through to their definitive treatment. [ABSTRACT FROM AUTHOR]