The operative treatment of unstable pelvic ring fractures.

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Abstract

[Indexed for MEDLINE] 19. Injury. 2014 Feb;45(2):374-8. doi: 10.1016/j.injury.2013.10.011. Epub 2013 Oct 18. Critical review of pelvic fractures associated with external iliac artery lesion: a series of six cases. Pascarella R(1), Del Torto M(2), Politano R(2), Commessatti M(3), Fantasia R(2), Maresca A(2). Author information: (1)Ospedali Riuniti di, Ancona, Italy. Electronic address: raffaele.pascarella@libero.it. (2)Ospedali Riuniti di, Ancona, Italy. (3)Unità di Ortopedia e Traumatologia, Ospedale Maggiore, Bologna, Italy. INTRODUCTION: Bleeding associated with pelvic fracture mostly comes from the pre-sacral and lumbar venous plexus, or directly from the fracture site. Bleeding as a consequence of arterial lesion is less common (15-20%), and that resulting from lesion of the external iliac artery (EIA) is extremely rare. The mortality rate associated with iliac artery injury ranges from 38% to 72%. Total body CT-scan with contrast medium, angiography or packing can be performed when there is arterial injury. In some cases, embolisation can stop bleeding; however, when there is involvement of the aorta, common iliac artery or EIA, immediate surgery is mandatory. The aim of this study was to report our experience of pelvic fractures associated with EIA lesion. MATERIALS AND METHODS: Six patients with pelvic fracture and associated rupture of the EIA have been observed at our unit from 2004 to 2009. According to Tile classification there were three cases of type C and two cases of type B fracture. One case was a two-column acetabular fracture. Angiography was performed in all cases. RESULTS: Three patients died on the day of trauma: two after angiography, and one after surgery of vascular repair. Three patients survived: two underwent a hemipelvectomy, and one underwent hip disarticulation. DISCUSSION: Haemodynamic instability in patients with pelvic ring fracture is usually because of venous bleeding from the pre-sacral and lumbar plexus, or from the fracture site. Arterial injury is present in around 20% of cases. EIA lesions require immediate surgical treatment to restore blood flow. Depending on the type of injury, vascular surgery can be associated with pelvic fracture stabilisation. CONCLUSIONS: Pelvic ring fracture associated with an EIA lesion is extremely rare, with few cases reported in the literature. Angiography is used for diagnosis, and immediate surgical treatment is required to restore blood flow. Associated injuries and open fracture can lead to fatal complications or amputation. Rates of mortality and severe disability are extremely high. Copyright © 2013 Elsevier Ltd. All rights reserved. DOI: 10.1016/j.injury.2013.10.011