Major vascular injuries secondary to pelvic fractures: An unsolved clinical problem

doi:10.1016/0002-9610(78)90331-8

The American Journal of Surgery

Volume 136, Issue 6, December 1978, Pages 660-662

https://doi.org/10.1016/0002-9610(78)90331-8 Get rights and content

Abstract

Twelve patients sustained sixteen pelvic fracture-related iliac and femoral arterial (5) and venous (11) injuries. Death was due in large part to delays in recognition and direct operative control of the major vascular disruption. Prompt operative exploration of all pedestrians admitted in hemorrhagic shock with open pelvic fractures characterized by a double break in the pelvic ring should reduce the 83 per cent mortality currently associated with this combination of injuries.

References (1)

DA Rothenberger et al.
The mortality of pelvic fractures

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El trauma perineal, aunque poco común, no es un evento raro. Puede presentarse con una amplia variedad de patrones de lesión y por esta razón necesita de una precisa evaluación diagnóstica y de tratamientos adecuados. Las lesiones traumáticas del periné pueden presentarse de manera aislada o asociarse a lesiones de otros órganos pélvicos, abdominales o de miembros inferiores. Por esta razón es importante conocer no solo la anatomía del periné y sus órganos sino también la relevancia del estado hemodinámico del paciente en el tratamiento de estas lesiones, de acuerdo con los protocolos de tratamiento del paciente politraumatizado. El propósito de esta revisión es describir las características de las lesiones traumáticas perineales, su presentación clínica y su tratamiento basado en la evidencia más reciente, para intentar definir líneas de diagnóstico y tratamiento específicas tanto en los pacientes en situación de inestabilidad como de estabilidad hemodinámica.
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Citation Excerpt :
Most vascular injuries are venous lesions and even those arterial injuries rarely affect the Femoral artery. The Superior Gluteal, Pudendal and Obturator arteries are the commonly injured arteries [4]. There have been small series of cases recording external iliac artery injury in pelvis fractures that were managed by aggressive vascular intervention [5–7].
This study reports a rare case of both column acetabulum fracture with femoral artery injury that presented late and was managed with arterial reconstruction and fracture fixation.
A thirty-one year old man sustained both column acetabular fracture on the left in a motor vehicle accident. On admission there was no obvious neuro-vascular deficit. During surgery for the fracture after 7 days of the injury the femoral artery was found to be severely crushed with no blood flow. The anterior column of the acetabulum was stabilised followed by resection and reconstruction of the femoral artery. The post-operative period was uneventful and he was discharged normally. At 6 months from injury the fractures had united well with excellent limb circulation and good lower limb function.
Femoral artery injury with acetabular fracture is rare and late presentations are unreported hitherto. The results of fracture stabilisation and vessel reconstruction seem to be excellent. Literature of similar injuries is reviewed.
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Pelvic fractures directly communicating with lacerations or puncture wounds of the skin, vagina, bowel, or rectum are defined as open. Rothenberger and colleagues33 found a mortality of 50% in patients with open pelvic fractures. He also reported an average blood loss of 29 units per patient.
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Pelvic angiography is an established technique that has evolved into a highly effective means of controlling arterial pelvic haemorrhage. The current dominant paradigm for haemodynamically unstable patients with pelvic fractures is angiographic management combined with mechanical stabilisation of the pelvis. However, an effective rapid screening tool for arterial bleeding in pelvic fracture patients has yet to be identified. There is also no precise way to determine the major source of bleeding responsible for haemodynamic instability. In many pelvic fracture patients, bleeding is from venous lacerations which are not effectively treated with angiography to fractured bony surfaces. Modern pelvic packing consists of time-saving and minimally invasive techniques which appear to result in effective control of the haemorrhage via tamponade. This review article focuses on the recent body of knowledge on angiography and pelvic packing. We propose the optimal role for each modality in trauma centres.
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^☆: This work was supported by the Saint Paul-Ramsey Hospital Medical Education and Research Foundation.

^☆☆: Presented at the Thirtieth Annual Meeting of the Southwestern Surgical Congress, Palm Springs, California, April 17–20, 1978.

¹: From the Department of Surgery, St. Paul-Ramsey Hospital, St. Paul, and the Department of Surgery, University of Minnesota Health Sciences Center, Minneapolis, Minnesota.

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Scientific paperMajor vascular injuries secondary to pelvic fractures: An unsolved clinical problem☆,☆☆

Abstract

The mortality of pelvic fractures

Scientific paper
Major vascular injuries secondary to pelvic fractures: An unsolved clinical problem☆,☆☆