Pre-peritoneal pelvic packing for the management of life-threatening pelvic fractures

Eur J Trauma Emerg Surg. 2019 Jun;45(3):417-421. doi: 10.1007/s00068-018-1018-4. Epub 2018 Oct 4.


Background: Pre-peritoneal pelvic packing (PPP) is a technique used for treating pelvic hemorrhage in patients with pelvic fractures and hemodynamic instability after a high-energy trauma representing a life-threatening situation. The aim of this study was to perform a comprehensive review of the literature.

Methods: A review of the medical literature was performed, based on the following inclusion criteria: patients sustaining pelvic fractures with hemodynamic instability and the inclusion of PPP as a tool for hemorrhage control. Articles not involving human patients, review articles, surveys, pediatric patients, hemodynamic stability, case reports, and not directly related publications; such as angiography with or without embolization, and REBOA use for hemorrhage control as a primary outcome evaluation were excluded from this search.

Results: Eleven articles out of seventy-seven identified publications between 2008 and 2018 met the inclusion criteria and were included in this review.

Conclusions: PPP is a surgical approach used in life-threatening situations due to pelvic fracture with high risk of death for exsanguination. Performed expediently, good results can be obtained with a decrease in the need for blood products, improved systolic blood pressure, and a decrease in mortality rates overall. This makes PPP an important life-saving tool.

Keywords: Hemodynamic instability; Pelvic fracture; Pre-peritoneal pelvic packing.

Publication types

  • Review

MeSH terms

  • Fractures, Bone / complications
  • Fractures, Bone / surgery*
  • Hemorrhage / etiology
  • Hemorrhage / surgery*
  • Hemostatic Techniques*
  • Humans
  • Pelvic Bones / injuries*