Pelvic fractures are found in 3-8% of patients with major trauma and accounted for 3.4% of all skeletal fractures.
Pelvic trauma is correlated with a significant level of morbidity and mortality and constitutes an important diagnostic problem and often damage of vascular structures is more clinically significant than skeletal (1).
These fracture are frequently associated with vascular,
nerve and soft tissuelesions,
causing major complications.
which are associated with pelvic bleeding are therefore the most important cause of hemodynamic instability in patients with...
Methods and Materials
Between 9/2010 and 12/2012 773 patients with major trauma underwent a CT (Ultra16Lightspeed,
GE) examination in emergency department.
Before entering the CT suite,
each patients was assessed for vital signs,
sedated and provided with mechanical ventilation if spontaneous breathing was judged to be insufficient.
Peripheral venous acces with a needle cannula at least 18 gauge was performed to allow administration of intravenous contrast material.
The study protocol involved a baseline followed by
a biphasic study,
in the arterial phase for the chest and...
Among 180 patients with pelvic injury,163 showed a pelvic hematoma; 27/180 patients showed a soft tissue hematoma (mainly glutes’),
22/27 associated with pelvic hematoma.
At CT active hemorrhage was identified in 47/180 cases (29 bleedings were visible in the arterial phase; 9 in the venous one; 2 in both of them; 11 near bone stumps).
All 47 patients underwent arteriography,
regardless of the type of bleeding detected.
Because of the continuing critical hemodynamic conditions,
20 patients underwent arteriography in the absence of active extravasation,
CT has high sensitivity to detect active bleeding and to establish its origin,
thus guiding the optimal therapeutic option to embolization or to the packing and fixation of fractures.
our experience suggests the practice of arteriography even in case of bleeding from bone stumps,
or of venous origin and in case of pelvic fracture or pelvic hematoma.
Even when there is an hemodynamic instability without relevant CT findings,
the choice of treatment is always the arteriography on the assumption that there may be appreciable...
Minei JP et al (2002) The importance of fracture pattern in guiding therapeutic decision-making in patients with hemorrhagic shock and pelvic ring distrupction.
J Trauma 53:446-451
Stern R et al (2005) Control of severe hemorrhage using C-clamp and arterial embolization in hemodinamically unstable patients with pelvic ring distruption.
Arch Orthop Trauma Surg 125:443-447
et al (1997) Arterial Embolization is a rapid and effective technique for controlling pelvic fracture hemorrhage.