Abstract
RATIONALE: Open pelvic fractures represent severe traumatic injuries with mortality rates approaching 50%. Complex cases involving multiple organ injuries and massive hemorrhage pose significant challenges in clinical management. Despite advances in trauma care, comprehensive documentation of successful management strategies for severe open pelvic fractures with multiple complications remains limited. PATIENT CONCERNS: A 36-year-old female presented with an open pelvic fracture following a motor vehicle collision, complicated by hemorrhagic shock (blood pressure 66/45 mm Hg), multiple organ injuries including bladder rupture and rectal damage, and an 18-cm open wound from the right groin to the anus with active bleeding. DIAGNOSES: Young and Burgess anterior-posterior compression III type pelvic fracture with vertical shear mechanism, bilateral internal iliac artery injuries, complete bladder and urethral rupture, and extensive perineal-rectal injuries. INTERVENTIONS: The patient underwent multiple staged interventions including emergency arterial embolization and stenting, external pelvic fixation, bladder repair, sigmoid colostomy, serial wound debridements, negative pressure wound therapy, and final reconstruction with muscle flap transposition and skin grafting. Treatment required 148 days of hospitalization, including 22 days in intensive care unit. OUTCOMES: The patient achieved successful recovery with healed fractures and wounds, though requiring permanent colostomy and cystostomy. Rehabilitation enabled functional recovery and return to daily activities. LESSONS: Successful management of complex open pelvic fractures requires prompt hemorrhage control through interventional procedures, implementation of damage control principles with staged surgical approaches, close multidisciplinary collaboration, and comprehensive wound care and infection management. This strategy can significantly improve survival outcomes in severe cases.