Hemorrhage associated with major pelvic fracture: a multispecialty challenge

Definitive treatment of life-threatening hemorrhage associated with blunt pelvic fracture remains controversial. To elucidate this issue, we reviewed 538 consecutive patients admitted with acute pelvic fracture during a 5-year period. Injury mechanism was motor vehicular in 214 (40%), falls in 152 (28%), auto-pedestrian in 92 (17%), motorcycle in 46 (9%), crush in 26 (5%), and assault or skiing in eight (1%). Ninety-two (17%) of these patients required greater than 6 units of blood transfusion during the first postinjury day, and are the primary focus of this report. Twenty-five patients (28%) had unilateral anterior (Group I, n = 20) or posterior (Group II, n = 5) fractures. The remaining 67 patients (72%) had anterior and posterior element involvement on the same side (Group II, n = 38), bilaterally (Group IV, n = 14), or open perineal wounds (Group V, n = 15). The PASG was applied in 47 patients (51%), and controlled hemorrhage in 12 (71%) of the 17 in whom it was used alone to tamponade pelvic bleeding. Peritoneal lavage was performed in 73 patients (79%). Initial aspirate yielded gross blood in 32 patients; 27 (84%) of these required urgent laparotomy. External skeletal fixation was applied in 19 patients; bleeding was controlled in 18 (95%). Pelvic angiography identified active hemorrhage in three patients and selective embolization was successful in two. Sixty-eight (74%) of the high-risk patients survived. Thirteen (54%) of the 24 deaths were attributable to the pelvic trauma, ten were due to recalcitrant bleeding, and three to delayed sepsis.(ABSTRACT TRUNCATED AT 250 WORDS)