Hemorrhage in major pelvic fractures

Area of Science:

• Trauma Surgery
• Emergency Medicine
• Radiology

Background:

• Major pelvic fractures frequently lead to significant hemorrhage.
• Prompt identification of pelvic fractures during trauma resuscitation is critical for effective blood loss management.

Purpose of the Study:

• To outline the essential management strategies for hemorrhage associated with major pelvic fractures.
• To highlight the role of diagnostic angiography and therapeutic embolization in managing pelvic fracture-related bleeding.

Main Methods:

• Review of resuscitative measures including pneumatic antishock garments and external fixation.
• Discussion of diagnostic angiography and therapeutic embolization techniques.
• Evaluation of decision-making between operative control and angiography for exsanguinating hemorrhage.

Main Results:

• Simple measures like pneumatic antishock garments are effective for most patients.
• External fixation devices can be beneficial for specific fracture patterns.
• Diagnostic angiography and therapeutic embolization are effective in approximately 3% of pelvic fracture patients with persistent hemorrhage.

Conclusions:

• Early recognition and management of pelvic fracture hemorrhage are vital.
• While initial resuscitation is key, angiography and embolization are indispensable tools for managing refractory bleeding.
• Complex cases may necessitate direct operative control, including hemipelvectomy or corpectomy.