Pelvic fractures represent high-mortality clinical entities due to acute hemorrhage and associated injuries in high-energy trauma. This review systematically addresses the emergency management of pelvic fractures, from initial assessment to mechanical stabilization, hemostatic surgical and angiographic procedures. Rapid clinical evaluation and imaging should be structured according to advanced trauma life support protocols, while hemostatic transfusion, tranexamic acid and permissive hypotension strategies within Damage Control Resuscitation should be applied simultaneously. The pelvic binder remains the first-line mechanical stabilization tool and may be supplemented with external fixator, C-clamp or T-clamp according to fracture pattern and hemodynamic status. Preperitoneal pelvic packing (PP) and angioembolization (AE) are complementary hemostatic options; PP is preferred particularly for venous hemorrhage control and as a bridge to AE, while AE is the definitive treatment for arterial bleeding. Resuscitative endovascular balloon occlusion of the aorta may be considered as a bridge procedure in selected cases, though its definitive role remains controversial. Genitourinary injuries, nerve damage and open pelvic fractures are important concomitant injuries adversely affecting long-term outcomes. Optimal emergency management of pelvic fractures requires rapid diagnosis, a multidisciplinary team approach and an algorithmic treatment process tailored to institutional conditions.