Case History 67 year-old Female patient, no relevant known history, is brought to the ER after being
run-over by a tractor. Clinical Findings At first evaluation, airway and ventilation were normal. She was slightly tachycardic but with normal blood pressure. A suprapubic open wound was found with active bleeding, initially managed with compression, with bone fragments and bladder evisceration. The
patient responded to initial resuscitation. Investigations / Diagnosis Full body trauma CT showed a complex open pelvic fracture, with significant comminution of the iliac and isquiopubic bones, as well as emphysema of the soft tissue with significant laceration and anterior bladder evisceration due to abdominal
wall injury. There was no posterior arch injury. Therapy and Progressions Initial damage control with pelvic packing was followed at 48hours later with open reduction and realignment of anterior pubic bone fragments as well as correction of the bladder herniation with an underlay polygactin mesh. She was discharged after 18 days, without signs of bone or soft tissue infection. Recovery was uneventful and two
months post op, the patient walked with walker support without significant complaints and no apparent incisional herniation. Comments Open pelvic fractures are rare but carry a high mortality, up to 50%. Exsanguination is an immediate concern and late complications due to pelvic sepsis are also frequent. As
such, successful management relies on swift multidisciplinary approach. An initial damage control approach followed by definitive treatment with a multidisciplinary team was the key in managing this challenging case, with low morbidity/mortality and good functional results.

No