Background: Pelvic fractures are frecuently associated with massive intrapelvic bleeding from venous or arterial sources. Different treatment algorithms has been proposed in order to stablish early control of haemorragic sites, mostly based on external fixation/angiography. The aim of present study was to evaluate the clinical evolution of 70 pelvic fractures with uncontrolled hypotension treated with combined ex fix/angio based on fracture pattern.

Materials and methods: Case serie . We analyzed a serie of patients admitted at our center between 1994 and 2004 with pelvic fracture and haemodinamic instability , treated by the same algorithm. Decision-making for the first treatment(angio vs external fixation) were based on the type of pelvic fracture. Patients was considered unstable if PAS was less than 90mmHg or the patients needs more than two blood products replacement in first 24 hours.

Results: External fixation was used in 45 patients(64%) and 37 patients were treated by angio. We found active arterial bleeding in 31 cases (44%). The combination of both treatment was used in 20 patients. Laparotomy was performed in 21 patients. Incidence of sistemic complications were high . Mortality was 26% . Mortality were higher in two groups: patients with TBI and those treated by laparotomy.

Conclusions: Arterial lesions demostrated by angio were high in our study(44%). In our experience a combined algorithm using both external fixation or angio based on type fracture control intrapelvic bleeding in most cases , although mortality in patients with pelvic fractre and haemodinamic instabilty remains high.