Pelvic fractures with active bleeding

Case contributed by Dr Heather Pascoe

Presentation

MBA at 90 km/hr.

Patient Data

Age: 30
Gender: Male

Bilateral displaced superior and inferior pubic rami fractures are present, associated with diastasis of the pubic symphysis. The right sacroiliac joint is ill-defined and likely widened. Extensive pelvic subcutaneous emphysema is present, likely extending into the retroperitoneum.

- Multiple displaced fractures of the pubic bones with extensive perineal and pelvic soft tissue injury.

- Pelvic hematoma predominantly on the left side with active bleeding. The bladder is displaced by the hematoma.

- Extensive subcutaneous emphysema involving the soft tissues of the pelvis extending into the retroperitoneum, paravertebral spaces and thighs. This is likely due to penetrating injury at the time of the accident.

- Fracture involving the sacrum on the right with extension into the right sacroiliac joint which is widened. 

- Right L4 and L5 transverse processes fractures.

Case Discussion

When pelvic fractures are detected, evidence of bleeding must be sought for. In patients with severe pelvic fractures, exsanguinating hemorrhage is the major cause of death within the first 24 hours. On CT, foci of active bleeding or large hematomas can be seen. If a patient is unstable, management options include pelvic embolization by an interventional radiologist and mechanical pelvic stabilization.

Injuries to the posterior urethra often accompany severe pelvic fractures.

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Case information

rID: 62178
Published: 5th Aug 2018
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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