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Life-threatening vascular injury in an elderly patient with isolated pubic ramus fracture: A case report
Evangelos Sakellariou1, Evangelia Argyropoulou2, Athanasios Galanis1
13 Department of Orthopaedic Surgery, KAT General Hospital, National & Kapodistrian University of Athens, Athens 14561, Greece.
Background:
Pubic ramus fractures are generally considered fragility fractures in the elderly population, commonly deriving from a low-impact fall. Treatment is ordinarily conservative and hemodynamic complications are exceedingly infrequent. Notwithstanding, patients with copious comorbidities should be carefully monitored for potential vascular injury.
Case Summary:
This case report presents the management of a 75-year-old male patient with a history of diabetes mellitus and arterial hypertension who was admitted to the emergency room with a superior pubic ramus fracture. The patient experienced a significant drop in hematocrit and hemoglobin levels post-admission, necessitating urgent intervention. A computed tomography angiography revealed active bleeding, leading to the embolization of the medial femoral branch. The patient was stabilized hemodynamically and was discharged after 15 days, with recommendations for home-based follow-up care.
Conclusion:
This report denotes the various challenges and strategies in managing simple fractures that are treated conservatively, but need prompt monitoring for occult vascular injuries that can be fatal.
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