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Updated: Jun 4, 2026
Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
Early embolization without external fixation in pelvic trauma
Shinsuke Tanizaki1, Shigenobu Maeda, Hiroyuki Hayashi
1Department of Emergency Medicine, Fukui Prefectural Hospital, Fukui 910-8526, Japan. sytanizak@yahoo.co.jp
Insights
Early pelvic embolization without external fixation is a viable initial treatment for hemodynamically unstable pelvic fracture patients. This approach, utilizing angiography and embolization, shows promise in managing severe pelvic injuries.
Area of Science:
- Trauma Surgery
- Interventional Radiology
- Emergency Medicine
Background:
- Pelvic fractures can lead to significant hemorrhage and hemodynamic instability.
- Traditional management often involves external fixation, which may delay definitive hemorrhage control.
Purpose of the Study:
- To evaluate the efficacy of early pelvic embolization without external fixation in managing pelvic fractures.
- To assess the safety and outcomes of this protocol in hemodynamically unstable patients.
Main Methods:
- Retrospective review of 88 patients with pelvic fractures managed with a protocol of hemodynamic resuscitation and early pelvic embolization.
- Patients with hemodynamic instability underwent angiography and embolization if CT showed pelvic extravasation.
- External fixation of the pelvic ring was deliberately avoided.
Main Results:
- 43 patients underwent angiography, with 29 (67%) showing positive findings for embolization.
- The average time to angiography was 76.3 minutes.
- The mortality rate among patients requiring angiography was 11%, with no embolization-related complications.
Conclusions:
- Early pelvic embolization, when combined with hemodynamic resuscitation and without external fixation, is a potentially effective initial management strategy.
- This protocol is particularly beneficial for patients with hemodynamic instability and evidence of pelvic extravasation on CT.
- The approach demonstrated acceptable outcomes without significant complications.
Purposes:
In this retrospective study, we reviewed our protocol consisting of early embolization without acute external fixation in patients with pelvic fracture.
Patients And Methods:
Eighty-eight patients with pelvic fracture were identified by reviewing the records of the Fukui Prefectural Hospital from April 2005 through September 2009. We managed the patients with a treatment protocol consisting of hemodynamic resuscitation and early pelvic embolization. Patients with hemodynamic instability without nonpelvic hemorrhage or extravasation of contrast in the pelvis by computed tomography (CT) were indicated to angiography and embolization. External fixation of the pelvic ring was not used in our protocol.
Results:
Of the 88 patients with pelvic fractures, 43 underwent angiography. Twenty-eight patients (65%) were hemodynamically unstable. Twenty-five patients (58%) had major ligamentous disruption. Computed tomography detected extravasation in 21 patients (48%). Of the 43 patients who underwent angiography, 29 (67%) were positive. The average time from hospital arrival to angiography was 76.3 ± 34.5 minutes. The packed red blood cell requirement in the initial 24 hours was 8.4 ± 8.2 U, required in the embolization group. There was no complication-related embolization. Repeat angiography was not required in all patients. The mortality rate of patients requiring angiography was 11%.
Conclusions:
Early pelvic embolization without external fixation may be useful for the initial treatment for patients with hemodynamic instability without nonpelvic hemorrhage or with extravasation of contrast in the pelvis by CT.
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Assessment:
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