Abstract
Aims: To describe the clinical characteristics, radiological classiþcation and management of 30 patients with severe pelvic injuries necessitating arterial embolization due to uncontrollable haemorrhage. Patients and methods: A prospective registration of patients admitted to our Level I- trauma hospital with pelvic fractures during a six year- period (1996-2002). Annually 168 patients had pelvic and acetabular fractures. The study group constituted of thirty of these patients where uncontrollable haemorrhage necessitated angiographic embolization of intrapelvic arteries. Results: 21 of the patients were male, on average 36 years old. All patients were subjected to high-energy traumas. Four had open pelvic fractures. One patient died in the initial phase due to multiple injuries. Average ISS score was 43,7. All patients had additional injuries, 50% were multitraumatized. Isolated sacral and acetabular fractures occurred in 5, the rest had pelvic ring injuries, 14 type B- and 11 type C-fractures. Deþnitive orthopaedic treatment was performed in 20 patients. There was a delay of 9 hours from admittance to embolization. Patients received 6,8 units prior to arrival at our unit, 15,4 units prior to embolization, 2 units 24-hours after embolization and 17,0 units from embolization to discharge. A total of 33, 9 units of erytrocytes was transfused at our unit. Time in angiography laboratory was 138 minutes. Branches of the internal iliac artery were affected in 28 patients, the superior gluteal artery being most frequently injured. Embolization was not effective in achieving haemostasis in 3. Conclusions: Pelvic fractures necessitating embolization due to uncontrollable haemorrhage are a result of high energy injuries and associated injuries are common. Arterial injuries associated with unstable pelvic haemorrhage are often due to injuries to branches of the internal iliac artery and early percutaneous embolization of these branches seems to control bleeding effectively.
Theses abstracts were prepared by Professor Dr. Frantz Langlais. Correspondence should be addressed to him at EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
