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Blunt abdominal trauma and severe pelvic rupture. What to do?

Severe pelvic injuries are often complicated by abdominal lesions. The main problem is excessive bleeding with threatening exsanguination. Bleeding originates mostly from the presacral venous plexus. By external fixation and reduction of the pelvic volume, the blood loss can be diminished or stopped. Laparotomy before external fixation will increase fracture dislocation and provoke further severe bleeding by loss of the tension band effect that the intact abdominal wall gives to the pelvis, protecting the latter against further symphysical diastasis.