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Despite mechanical stabilization and angioembolization, pelvic fracture with hemodynamic instability is associated with a mortality rate of 15% to 40%. Approximately 85% of pelvic fracture–related hemorrhage is venous in origin. Investigators at a single level I trauma center report their experience (from September 2004 to June 2006) with a technique called preperitoneal packing (PPP) that allows direct compression of venous bleeds.
Patients with persistent systolic blood pressure <90 mm Hg despite transfusion of two units of packed red blood cells, including those going to the operating room for other thoracic or abdominal interventions, were eligible for the procedure. PPP was preceded by placement of an anterior external fixator or poster…