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Pelvic fractures occur in up to 25% of all severely injured trauma patients and its mortality is markedly high despite advances in resuscitation and modernization of surgical techniques due to its inherent blood loss and associated extra-pelvic injuries. Pelvic ring volume increases significantly from fractures and/or ligament disruptions which precludes its inherent ability to self-tamponade resulting in accumulation of hemorrhage in the retroperitoneal space which inevitably leads to hemodynamic instability and the lethal diamond. Pelvic hemorrhage is mainly venous (80%) from the pre-sacral/pre-peritoneal plexus and the remaining 20% is of arterial origin (branches of the internal iliac artery). This reality can be altered via a sequential management approach that is tailored to the specific reality of the treating facility which involves a collaborative effort between orthopedic, trauma and intensive care surgeons. We propose two different management algorithms that specifically address the availability of qualified staff and existing infrastructure: one for the fully equipped trauma center and another for the very common limited resource center.

David Alejandro Mejia, • Department of Surgery, Hospital Pablo Tobon Uribe, Medellin, Colombia. • Department of Surgery, Universidad de Antioquia, Medellin, Colombia.

orcid_id14.png https://orcid.org/0000-0003-0617-4303

Michael Parra, Department of Trauma Critical Care, Broward General Level I Trauma Center, Fort Lauderdale, FL – USA

orcid_id14.png https://orcid.org/0000-0001-6496-6275

Carlos Alberto Ordoñez, • Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia. • Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. • Universidad Icesi, Cali, Colombia.

orcid_id14.png https://orcid.org/0000-0003-4495-7405

Natalia Padilla, Centro de Investigaciones Clínicas (CIC), Fundación Valle del Lili, Cali, Colombia

orcid_id14.png https://orcid.org/0000-0003-3292-6919

Yaset Caicedo, • Centro de Investigaciones Clínicas (CIC), Fundación Valle del Lili, Cali, Colombia

orcid_id14.png https://orcid.org/0000-0002-6128-0128

Salin Pereira-Warr, Grupo de Soporte Nutricional. Hospital Pablo Tobón Uribe. Medellin. Colombia

orcid_id14.png https://orcid.org/0000-0002-8259-8274

Paula Andrea Jurado, Department of General Surgery. Hospital Pablo Tobón Uribe – Universidad de Antioquia, Medellín, Colombia

orcid_id14.png https://orcid.org/0000-0002-6688-9944

Alfredo Martinez, Department of Orthopedic Surgery. Fundación Valle del Lili. Cali, Colombia

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Jose Julian Serna, • Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia. • Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. • Universidad Icesi, Cali, Colombia. • Division of Trauma and Acute Care Surgery, Department of Surgery. Hospital Universitario del Valle, Cali, Colombia.

orcid_id14.png https://orcid.org/0000-0001-9829-8930

Fernando Rodriguez, Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia.

orcid_id14.png https://orcid.org/0000-0002-5326-2317

Alexander Salcedo, • Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia. • Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. • Universidad Icesi, Cali, Colombia. • Division of Trauma and Acute Care Surgery, Department of Surgery. Hospital Universitario del Valle, Cali, Colombia.

orcid_id14.png https://orcid.org/0000-0001-8187-0638

Alberto Garcia, • Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia. • Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. • Universidad Icesi, Cali, Colombia.

orcid_id14.png https://orcid.org/0000-0002-4096-1434

Mauricio Millan, • Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia. • Division of Transplant Surgery, Department of Surgery, Fundación Valle del Lili, Cali, Colombia

orcid_id14.png https://orcid.org/0000-0002-5502-5745

Luis Fernando Pino, • Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. • Division of Trauma and Acute Care Surgery, Department of Surgery. Hospital Universitario del Valle, Cali, Colombia.

orcid_id14.png https://orcid.org/0000-0002-1179-2854

Adolfo Gonzalez Hadad, • Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. • Division of Trauma and Acute Care Surgery, Department of Surgery. Hospital Universitario del Valle, Cali, Colombia. • Centro Médico Imbanaco, Cali, Colombia

orcid_id14.png https://orcid.org/0000-0001-5862-4906

Mario Alain Herrera, • Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. • Division of Trauma and Acute Care Surgery, Department of Surgery. Hospital Universitario del Valle, Cali, Colombia.

orcid_id14.png https://orcid.org/0000-0002-4526-7636

Ernest Moore, Department of Surgery, University of Colorado, Denver Health Medical Center, Denver, CO USA.

orcid_id14.png https://orcid.org/0000-0002-0419-4848

Mejia, D. A., Parra, M., Ordoñez, C. A., Padilla, N., Caicedo, Y., Pereira-Warr, S., Jurado, P. A., Torres, M., Martinez, A., Serna, J. J., Rodriguez, F., Salcedo, A., Garcia, A., Millan, M., Pino, L. F., Gonzalez Hadad, A., Herrera, M. A., & Moore, E. (2020). Hemodynamically Unstable Pelvic Fracture: A Damage Control Surgical Algorithm that Fits your Reality. Colombia Medica, 51(4), e4214510. https://doi.org/10.25100/cm.v51i4.4510

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