Pelvic fracture hemorrhage. Priorities in management
B. M. Evers, H. M. Cryer and F. B. Miller
Department of Surgery, University of Louisville School of Medicine, KY.
Hemorrhage remains the leading cause of mortality in patients with severe
pelvic fractures. To evaluate diagnostic and treatment priorities for this
problem, we retrospectively reviewed 245 consecutive patients admitted to
our institution with pelvic fractures. Supraumbilical diagnostic peritoneal
lavage (DPL) was grossly positive in 27 patients, and eight (30%) of these
had life-threatening intra-abdominal hemorrhage identified at laparotomy.
No patient with a positive DPL by count alone had life-threatening
intra-abdominal hemorrhage. Pelvic fracture stabilization with early
external pelvic fixation was associated with less requirement for blood
transfusion (10 +/- 1 U) than with the pneumatic antishock garment (17 +/-
3 U). Nine patients with pelvic arterial injuries underwent angiographic
embolization, and eight patients died (89%). We conclude that pelvic
angiography should be performed before laparotomy in hemodynamically
unstable patients with pelvic fracture, unless the DPL is grossly positive.
