<![CDATA[Hemorrhage associated with pelvic fractures can lead to hemorrhagic shock and death, while bleeding-control strategies have been reported with varying levels of evidence. This systematic review aimed to synthesize the available scientific evidence by mapping bleeding-control strategies, assessing their effectiveness, and identifying factors influencing their success. This study was a systematic literature review with a narrative synthesis of 16 articles published between 2021 and 2026, comprising two narrative reviews, two case reports, and twelve retrospective observational studies. Data were extracted using a standardized form and grouped according to three research questions. The results identified five groups of strategies: mechanical stabilization, pelvic packing, endovascular intervention, transfusion resuscitation, and innovative techniques. External fixation and pelvic binders showed no significant difference in mortality. Angioembolization combined with external fixation demonstrated a hemostasis success rate of 97.78% and a mortality rate of 4.44%, compared with 82.22% and 24.44%, respectively, for external fixation alone. Mortality associated with REBOA showed no significant difference, even after matching. Delayed embolization was associated with higher mortality, while age, level of consciousness, fracture pattern, and associated injuries also influenced patient outcomes. Therefore, prevention of hemorrhagic shock in pelvic fractures is best achieved through a layered strategy implemented promptly and tailored to the patient’s clinical condition.]]>
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