Acute management of pelvic ring injuries: identifying common treatment principles across institutional algorithms

INTRODUCTION: Pelvic ring injuries are associated with substantial morbidity and mortality, particularly in patients presenting with hemodynamic instability and major hemorrhage. Numerous institutions have developed management algorithms for the acute treatment of pelvic ring injuries; however, the common principles underlying these pathways remain unclear. METHODS: A systematic review was conducted in accordance with the PRISMA 2020 guidelines. PubMed/MEDLINE, Embase, and Scopus were searched on January 8, 2026, for peer-reviewed publications published from January 1, 2006, through December 31, 2025 that described algorithms, pathways, or protocols for the acute management of pelvic ring injuries. Two independent reviewers performed study selection and data extraction. Algorithm components related to mechanical stabilization, physiologic assessment, imaging, hemorrhage control, and damage control resuscitation were extracted and compared using descriptive quantitative and qualitative synthesis. RESULTS: The search identified 328 records that underwent title and abstract screening, and 63 articles were assessed for full-text eligibility. Twenty-five studies were included in the final analysis. All included algorithms (25/25, 100%) used physiology-based decision-making. Early noninvasive mechanical stabilization was specified in 23/25 algorithms (92%); pelvic binders were specified in 17/25 (68%). Angiography with potential angioembolization was included in 19/25 algorithms (76%), exploratory laparotomy in 10/25 (40%), and resuscitative endovascular balloon occlusion of the aorta (REBOA) in 3/25 (12%). Computed tomography was incorporated into 20/25 algorithms (80%), whereas pelvic radiography was included in 18/25 (72%). Fracture morphology was used as a treatment decision point in 4/25 algorithms (16%), and pelvic packing was described in 20/25 publications (80%). CONCLUSION: Published algorithms for the acute management of pelvic ring injuries demonstrate substantial consistency despite institutional variation. Early mechanical stabilization, physiologic assessment, damage control resuscitation, radiologic evaluation, and structured hemorrhage-control pathways were identified as the most common components of contemporary management algorithms.