Vascular injuries associated with pelvic fractures

Pelvic fractures, which are most often caused by blunt abdominal trauma in our motor vehicle-oriented society, continue to be associated with significant mortality and morbidity. Hemorrhage is the cause of death in nearly 60 per cent of those patients who die of pelvic fractures. With increasing awareness of the problem and improved methods of management, the mortality rate of acute hemorrhage secondary to pelvic fracture should decrease. Four cases of vascular injuries associated with severe pelvic fractures are discussed. One patient presented with bleeding from a false aneurysm of the superior gluteal artery 3 months after his pelvic fracture. This complication was successfully managed by selective arteriographic embolization. The other three patients required early angiography with embolization of hypogastric vessels to control acute hemorrhage after pelvic fracture. Pelvic arteriography with selective embolization of injured vessels is recommended in the management of hemorrhage secondary to severe pelvic fractures. Application of the Military Antishock Trousers (MAST) suit may also be a useful maneuver. These principles of management and a pertinent review of the literature are presented.