Management of Low-Velocity Ballistic Pelvic Fractures: A Current Concept Review

Low-velocity ballistic pelvic fractures represent complex injuries that combine osseous disruption with variable degrees of soft-tissue, visceral, and vascular involvement. In civilian settings, these injuries are most commonly associated with low-velocity firearms and carry a distinct risk profile compared with high-velocity ballistic trauma. Complications include infection related to bowel contamination, septic shock, and life-threatening hemorrhage. Optimal management requires a coordinated, multidisciplinary approach and a clear understanding of indications for operative versus nonoperative treatment. Contemporary literature supports short-course, broad-spectrum antibiotic prophylaxis as an effective strategy for infection prevention in most low-velocity injuries. Operative interventions, such as fecal diversion, debridement, and washout, should be selectively employed, as aggressive surgical management may increase infectious morbidity in otherwise stable patients. Removal of retained bullets is generally unnecessary except in cases of intra-articular involvement, where extraction is recommended to prevent lead toxicity. This Current Concepts Review synthesizes available evidence on antibiotic strategies and surgical management of low-velocity ballistic pelvic fractures and highlights critical gaps in the literature that warrant higher-quality, prospective investigation.