Selective temporary angioembolisation in older adults with pelvic trauma - Two cases

Hemorrhage is a major concern in the management of high-energy pelvic and acetabular fractures, with complex acetabular patterns often associated with significant blood loss. While angioembolization is well-established in pelvic trauma, its role in temporarily minimizing intraoperative hemorrhage during acetabular fixation remains underexplored. This report presents two cases of polytraumatized older adults with combined pelvic ring and complex acetabular fractures managed with preoperative selective, temporary angioembolization. Case 1 involved a 76-year-old male with hemorrhagic shock and multiple injuries, including a left associated both-column (ABC) acetabular fracture and superior gluteal artery bleeding. Case 2 involved a 68-year-old male with a right ABC acetabular fracture and multilevel internal iliac artery injury following an avalanche. Both patients underwent early selective angioembolization with gelatin sponge prior to staged fracture fixation using combined intra- and extrapelvic surgical approaches. In both cases, cumulative intraoperative blood loss was limited to <1200 mL despite the need for extensive fixation involving multiple surgical windows and approaches. Postoperative recovery was favorable, with both patients regaining independent ambulation and functional hip mobility. No embolization-related complications or surgical site infections were observed. Preoperative bleeding in acetabular fractures often originates from cancellous bone and arterial branches, including the superior gluteal and obturator arteries. Intraoperative hemorrhage remains a significant challenge, particularly in elderly or physiologically compromised patients. Selective, temporary angioembolization appears to be a promising adjunct for minimizing intraoperative hemorrhage in high-risk patients undergoing combined pelvic and acetabular fracture fixation. Further studies are warranted to evaluate its efficacy and safety in broader clinical contexts.