Hundersmarck D, Hietbrink F, Leenen LPH, et al. - In view of the challenges and controversies concerning the treatment of pelvic trauma related hemorrhage, researchers here examined the effectiveness and safety of performing pre-peritoneal packing (PPP) with temporary external fixation (EF) and subsequent trans-arterial embolization (TAE) in hemodynamically unstable patients suspected for massive bleeding, in order to control bleeding, as well as of performing primary TAE with EF in hemodynamically stable patients suspected for minor to moderate bleeding. Retrospective evaluation was performed of 135 patients that were provided treatment for pelvic trauma-related hemorrhage at two level 1 trauma centers located in the United States between January 2001 and January 2019. Outcomes suggest effectiveness and safety of  primary TAE as an adjunct for (minor) pelvic hemorrhage in hemodynamically stable patients. Those suspected of massive pelvic bleeding may be effectively managed with performing primary PPP followed by EF and adjunct bilateral unselective TAE with gelfoam. This unselective embolization strategy using gelfoam might be due to (ischemic) complications. When accounting the amount and severity of complications and the severity of pelvic trauma, the benefit of fast hemorrhage control might not be outweighed.