Hemorrhage in major pelvic fractures

Abstract

Significant hemorrhage following major pelvic fractures should always be expected. Early recognition of such fractures during the resuscitation of any multiply injured patient is essential before instituting measures that might combat blood loss. In the majority of patients, simple resuscitative measures, including employment of the pneumatic antishock garment, will suffice. With certain types of fracture geography, the early application of external fixation devices may also play an important role. Increasingly popular has been the technique of diagnostic angiography and therapeutic embolization, applicable to approximately 3 per cent of all pelvic fracture patients. With exsanguinating hemorrhage, even the best equipped and most sophisticated major trauma centers can be taxed. The decision whether a patient should be taken directly to the operating room or to the angiography suite remains one of the most difficult for even the most highly skilled trauma surgeon. Patients with rapidly expanding or free rupture of pelvic hematomas noted at the time of celiotomy, or those with large open wounds, usually leave no recourse but to attempt direct operative control, to include even the most morbid option of a life-saving hemipelvectomy or corpectomy. More often, however, once other sources of surgically correctable hemorrhage are controlled or ruled out, diagnostic angiography followed by therapeutic embolization is a mainstay in the modern-day management of pelvic fracture hemorrhage.