Fragility fractures of the pelvis (FFPs) are increasingly encountered in older adults with osteoporosis, typically after low-energy mechanisms of injury, such as a fall from standing height, as well as falls without a clear traumatic event. Plain radiography may underestimate the extent of posterior pelvic ring injuries ; therefore, pelvic CT is recommended once an anterior ring fracture, such as a pubic rami fracture, is identified or strongly suspected. The Rommens-Hofmann FFP classification stratifies fractures by instability and provides a practical framework for treatment decisions. Although conservative management with adequate analgesia and early mobilization remains the cornerstone for FFP type I and selected type II injuries, a substantial subset of type II fractures develops persistent pain, delayed mobilization, or fracture progression. Minimally invasive fixation may facilitate early functional recovery in these patients. Importantly, despite their low-energy nature, FFPs can be complicated by clinically significant hemorrhage, particularly in patients on antithrombotic therapy or with posterior ring involvement. Acute-phase management should incorporate risk-based monitoring, contrast-enhanced CT when indicated, and timely angioembolization for arterial bleeding.

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　　Traumatic hemorrhage is the leading cause of trauma-related mortality and is driven by trauma-induced coagulopathy arising from tissue injury-related pathophysiological processes such as shock, dilution, hypothermia/acidosis, and hypocalcemia. Countermeasures include damage control resuscitation and massive transfusion protocols, which recommend the early administration of balanced amounts of red blood cells, fresh frozen plasma, and platelets. Potential countermeasures include coagulation factor-targeted therapies, such as fibrinogen concentrate, cryoprecipitate, prothrombin complex concentrate (factors II, VII, IX, and X), and factor XIII, as well as ionized calcium supplementation, in conjunction with whole blood transfusion, refrigerated platelets, and freeze-dried plasma. Anti-fibrinolysis is primarily centered on tranexamic acid. Its efficacy is dependent on the timing of administration and the fibrinolytic phenotype. Herein, we outline the evidence supporting these approaches and discuss goal-directed resuscitation aimed at achieving "functional hemostasis" before surgical hemostasis.

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