TITLE:
Multidisciplinary Staged Management of an Unstable Open Pelvic Fracture with Perineal Injury: A Case Report and Literature Review
AUTHORS:
Andrés David Ahumada-Uribe, Paula Chacón-Madera, Karla Mendoza-Leottau, Valentina Llerena-Montoya, Luisa Bello-Lopez, Emil Fonseca-Padilla, Bella Solarte-Martinez, Johann Ramírez-Díaz, Juan Pablo Pérez-Cano, Guillermo Caro-Narvaez, Stefany Reales-Muñoz, Camilo Blanco-Teheran
KEYWORDS:
Open Pelvic Fracture, Damage Control Surgery, Pelvic Trauma, Perineal Injury, Multidisciplinary Management, Orthopedic Trauma
JOURNAL NAME:
Journal of Biosciences and Medicines,
Vol.14 No.9,
September
21,
2026
ABSTRACT: Background: Open pelvic fractures accompanied by extensive perineal soft-tissue injury are uncommon but represent one of the most challenging scenarios in trauma surgery. Their management requires rapid hemorrhage control, early contamination control, staged orthopedic stabilization, and close collaboration among multiple surgical specialties. We present a case illustrating a staged multidisciplinary strategy and review the current evidence supporting this approach. Case Presentation: A young patient sustained a high-energy pelvic trauma resulting in an unstable open pelvic fracture associated with a large perineal wound and intra-abdominal injuries. Initial evaluation demonstrated severe disruption of the perineal soft tissues and radiologic evidence of an unstable pelvic ring injury with associated intra-abdominal pathology. Following Advanced Trauma Life Support (ATLS) principles, the patient underwent emergency damage control surgery consisting of exploratory laparotomy, control of intestinal contamination, fecal diversion, pelvic packing, and temporary hemorrhage control. Subsequent operative exploration confirmed extensive disruption of the perineal structures requiring staged debridement and reconstruction. Once physiologic stabilization was achieved, definitive internal fixation of the pelvic ring was performed successfully, followed by continued wound management until satisfactory recovery. Conclusion: This case highlights that survival after severe open pelvic trauma depends less on immediate definitive orthopedic reconstruction than on a carefully coordinated staged multidisciplinary strategy. Early hemorrhage control, aggressive contamination management, repeated debridement, and delayed definitive fixation constitute the fundamental principles associated with improved outcomes in these devastating injuries.